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CATALOGUE

OP THB

PATHOLOGICAL MUSEUM,

MEDICAL COLLEGE, CALCUTTA.

J. F. P. McCONNELL, m.b. ; m.c. ; m.r.c.s. eng.;

MEM. TATT1. SOC., LONE.;

PROFESSOR OF PATTIOLOOY AND CURATOR OF THE MUSEUM.

Calnttta:

PRINTED AT THE BENGAL SECRETARIAT PRESS.

1881.

[T ,010 € INSTITUTE
LIBRARY

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PREFACE.

On the completion of the present work, the first duty of the
author is to record the fact that, but for the encouragement and
support given to the undertaking by the Government of Bengal,
it, could never have been accomplished. When the preparation
of a Descriptive Catalogue of the very valuable collection of
pathological specimens in the Museum of the Medical College was
proposed, and the plan of the work submitted to Sir Ashley Eden,
His Honor was pleased to accord his sanction to the undertaking,
and to issue orders for its publication by the Secretariat Press ;
moreover, during the progress of the work, the author’s efforts
to do justice to it have been keenly stimulated by the kindly
interest taken in it by the Lieutenant-Governor.

The Pathological Museum of the Calcutta Medical College
was founded, about the year 1839, upon the collection of morbid
specimens which belonged to the old Medical and Physical Society
of this city.

It was greatly added to by Professor Allan Webb, one
of the earliest curators, whose very valuable treatise, entitled
Pathologia Im/ica, based upon his own personal researches, marked
an important era in the history of Medical Science in India, and
which, by its extensive learning, may be said to have fairly
established for its author the right of being regarded as the
pioneer of Indian pathology.

Many of Professor Webb’s preparations have, unfortunately,
now been lost to the collection, chiefly owing to the changes
which, in the course of time, are but too apt to occur in
such a climate as that of Bengal. A few of them, however, still
remain, and these have been carefully guarded, not less on
account of their historical interest than for their intrinsic value.

The chief contributors to the Museum, of late years, have
been the successive Curators, and the Medical Officers constituting
the Staff of the Calcutta Medical College Hospital ; but many
interesting and valuable specimens have also been received from

PREFACE.

Medical Officers in Civil and Military employ throughout the
Bengal Presidency.

The past history of the Museum is associated with the names
of many distinguished members of the profession in India, such
as those of Mouat, Edward Goodeve, Jackson, O’Shaughnessy,
Herbert Baillie, Norman Che vers, Chuckerbutty, Charles,
Fayrer, and Partridge,

"With these time-honoured names it is also necessary to
mention those of two Native Teachers of this Medical School in
former days — Pai Pam Narain Das Bahadoor (whose collection
of vesical calculi is of undoubted value), and Moulvie Tameez
Khan Bahadoor, whose sound and extensive knowledge of patho-
logy has always been zealously devoted to the improvement of
this Museum.

For a long time the want of a suitable catalogue was much
felt. In 1865, Dr. Joseph Ewart published a descriptive cata-
logue of 1,322 preparations. This work was, for some years, a
useful source of reference.

During the temporary absence of Dr. Ewart, in Europe, in
1864-65, the late Dr. J. A. Purefoy Colles was in charge of the
Museum. This excellent anatomist and most careful observer
contributed largely to the collection ; and his many descriptions
are, as might have been expected, accurate, lucid, and of real
scientific value.

Dr. Ewart resumed charge of the Museum in 1865, and
retained the office until relieved by the present Curator in the
year 1872.

During the first two years of the author's incumbency, his
time was fully occupied in the preparation of a course of lectures
on Pathology and Morbid Anatomy, and in the performance of the
duties devolving on him as Pathologist to the College Hospital,
and Lecturer in the Medical School, — it was not, therefore,
until the year 1874 that a complete revision of all the preparations
in the Museum could be undertaken.

This work has now occupied the author’s attention, and all
his available leisure, for the last seven years.

PREFACE.

Had his duties been less multifarious, and had there not
been an entire absence of skilled assistance in the Museum, this
Catalogue might have appeared sooner ; but the delay in its
publication has, it is hoped, added to its completeness and
value.

A The Catalogue, as it now stands, has been arranged in
accordance with that most familiar to the author; viz., the Patho-
logical Catalogue of the Museum of Sfc. George s Hospital,
London (the joint production of his esteemed masters Dr. John
W. Ogle and Mr. Timothy Holmes). The only modifications
that have been introduced are such as seemed desirable in deal-
ing with a large number of morbid specimens not commonly
met with in European museums.

"With regard to the arrangement of this volume, — in the
table of contents will be found the different “ series ” in which
all the specimens have been separately placed and described.
Each “ series ” has its own classified “ index ” of preparations ;
and at the end of the work there is a complete “ general index ”
to the whole of its contents. It is hoped, therefore, that refer-
ence to any part of the volume, or to any subject illustrated by
specimens in the Museum, will be found easy, not only to the
Professors, but to the most junior student.

The Catalogue comprises the description of nearly three
thousand (2,890) morbid specimens, exclusive of a series of Casts,
Wax Models, and Pathological Drawings, forming Appendix A,
and numbering 249.

Care has been taken, whenever it was possible, to place on
record the ff life-histories ” of the preparations preserved, as cal-
culated greatly to enhance their value ; and, with the same object,
references have also been furnished to the Mortuary Records of the
College Hospital. These Records have now been systematically
collated since the year 1873.

It may be mentioned that the Museum is particularly rich in
certain directions —

(a.) Very valuable specimens of diseases affecting the
Digestive organs (Series IX), specially illustrative
of the disorders most prevalent in tropical climates.

PREFACE.

{b.) Morbid lesions of the Heart and Blood-Vessels
(Series VI).

(c.) A large, varied, and excellent collection of preparations
of Tumours (Series XVII).

(tf.) A comprehensive and valuable collection of Vesical
Calculi.

By recently improved methods of sealing the jars (which
need not here be particularized), it has been found possible to
preserve, for years, the specimens which they contain without
the loss of the spirit, by evaporation, which has hitherto proved
so detrimental to the preservation of pathological preparations in
this country.

There remains to be considered one very important point, viz.,
to what degree such Descriptive Catalogues as the present, and
indeed how far Museums generally, are to be considered of real
value to the conscientious student of science.

It is hardly possible to express an opinion on such a question
as this more forcibly than has recently been done by Sir James
Paget, whose utterances regarding everything bearing on Medical
Science command the greatest respect in all parts of the civilized
world. “ It is said indeed by some,” he observes,* “ but chiefly
I think by those who desire to find reasons for not studying —
that specimens of diseased structures are so altered in their
preparation for a museum, that they are quite unfit for the
teaching or the study of pathology. The same objection might
be made to the study of botanical specimens in an herbarium.
In both cases alike, the changes produced in preparation are
so far uniform that any one accustomed to recent specimens
(and no others should study either herbaria or pathological
museums) can allow for them, or ‘discount’ them. Just
as an anatomist can discern, in a recent specimen of disease,
the healthy structure, so — but often much more clearly — can
the pathologist or any careful student discern, in the prepared
specimen, the chief characteristics of the disease. Or, as none

• “ Suggestions for the making of Pathological Catalogues ,” a Paper read at the
Biitish Medical Association Meeting at Cambridge, 1880. Vide British Medical Journal,
lltli December 1880, p. Oil.

PREFACE.

know better the use of dissecting dead and decaying bodies than
those who operate upon the living, so may all find, when they are
studying at the bed-side, the most potent help in their memories
of what they have seen in the museum. Or, even without argu-
ment, it may suffice to answer those who deprecate pathological
museums and catalogues, that they who study in them carefully
do fiud them very useful.”

In this opinion the author fully concurs, and he hopes that
this volume may in some measure assist all earnest students, into
whose hands it may fall, to a deeper and more precise know-
ledge of the laws of General Pathology, and of the nature of
diseased structures — than which no knowledge can be said to be
of more importance in its relations to Practical Medicine and
Surgery.

Medical College ; J. F. P. McConnell.

Calcutta, February 1882. j

CONTENTS.

Series.

I. — Fractures and Dislocations

II. — Diseases of the Bones ...

III. — Diseases of the Joints ...

IV. — Injuries and Diseases of Muscle, &c.

Y. — Diseases of the Spine ...

VI.— Injuries and Diseases of the Pericardium, Heart, Arteries

and Veins ... ... **• ••• 107 to 204

VII. — Injuries and Diseases of the Larynx, Trachea. Bronchi

and Bronchial Glands; of the Lungs and Pleura ... 207 to 241

VIII. — Injuries and Diseases of the Brain and Spinal Cord with

their Membranes and Blood-vessels ; also of the Nerves 242 to 271

IX.— Injuries and Diseases of the Tongue, Tonsils. Pharynx.
(Esophagus, Stomach, Intestines, Peritoneum, Liver
and Pancreas, &c. ... ... ... ... 275 to 359

X. — Injuries and Diseases of the Spleen, Thyroid Gland,

Supra-renal Capsules, and Lymphatic Glands ... 363 to 382

XI. — Injuries and Diseases of the Kidneys and Ureters ... 383 to 411

XII. — Injuries and Diseases of the Bladder, Urethra, and Prostate

Gland ... ... ... ... ... 415 to 430

XIII. — Injuries and Diseases of the Male Organs of Generation... 431 to 446

XIV. — Injuries and Diseases of the Female Organs of Generation 447 to 474

XV. — Diseases of the Mammary Gland ... ... ... 477 to 486

XVI. — Diseases of the Organs of Special Sense, and of the Skin ... 487 to 515

XVII. — Tumours and Morbid Growths ... ... ... 519 to 611

XVIII. — Malformations, Misplacements, and Diseases of the Ovum

(Congenital Malformations and Deformities generally)... 615 to 628

XIX. — Entozoa from various parts of the body ... ... 629 to 642

XX. — Calculi, Concretions, and Foreign Bodies from the Urinary

and Digestive Organs, and from other parts of the body 643 to 682

Page.
From — To
1 to 42
... 43 to 79
... 83 to 96

... 97 to 99
... 100 to 103

Appendix A. — Casts, Wax Models,
Drawings ...

Appendix B.— Additional preparations
General Index

and Pathological

...683 to 707

...708 to 717
...719 to 734

CATALOGUE

r -

OJ? THB

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PART I.

THE INJURIES AND DISEASES OF BONE.

Series I and II.

Series I.

FRACTURES AND DISLOCATIONS.

INDEX TO THE SERIES.

A.— ANATOMICAL : showing the bone and part of the bone

INVOLVED.

{United fractures are marked with a +•)

I. — Fractures of the bones of the Skull and Face —

(a) Vertex. — Parietal, 1, 2, 3f. 4, 5, 6, 7, 8, 9, 10, 11, 19, 22.

Frontal, 1, 4, 6, 8, 11, 12, 13, 14, 15, 16, 17, 18, 19.
Temporal, 6, 20. 21, 26, 27.

Occipital, 1, 5, 22, 23, 24.

Separation of sutures, 1, 2, 4, 5, 9, 15, 19, 20, 23, 27.

(b) Base. — Anterior fossa, 20, 21, 25.

Middle fossa, 20, 25, 26, 27, 28.

Posterior fossa, 20, 25, 26, 28.

Superior maxillary, 20.

Inferior , 20, 29, 30.

Gunshot injuries of the head, 31, 32.

Multiple fracture from lightning, 33.

Craniotomy, 33a. „

II.— Fractures and Dislocations of the Spine* —

(a) Fractures in the cervical region, 34, 35, 36, 37, 38, 39, 40, 41, 42.
43, 44, 45.

{b) Dislocations in the cervical region, 36, 42, 44, 46, 47, 48, 49, 58.

(d) Dislocations in the dorsal region, 50.

(e) Fractures in the lumbar region, 52, 53f, 54, 55, 56, 57.

( f ) Dislocations in the lumbar region, 55, 56, 57.

(g) Gunshot injuries, 58, 59.

(/*) Sword or dhao wound, 60.

* Includiug also injuries of the intervertebral cartilages.

FRACTURES AND DISLOCATIONS.

[SEBIES I.

III. — Fractures of tiie Bones and Cartilages of the Chest —

(a) Ribs, 61f, 62, 63.

(5) Sternum, 63.

IY. — Fractures of the Clavicle and Scapula —

(a) Clavicle, 64f, 65f.

( b ) Scapula, 66, 67.

Y. — Fractures and Dislocations of the Bones of the Upper Ex-
tremity—

(a) Fractures of the Humerus — upper end, 68f, 69.

(b) shaft, 69, 70, 71, 72

79. 80, 81.

(d) both bones of the forearm, 71, 83, 84, 85, 86.

87.

( e ) radius, 77, 88. 89.

(/) the ulna, 76.

(<j) the bones of the carpus, 90.

()i) metacarpus and phalanges,

90, 91, 92, 93f.

(i) Dislocations of the elbow, 94, 95, 96.

\j) Gunshot injuries, 82, 97, 98.

VI. — Fractures of the Pelvis —

[a) Pubes, 99.

\b) and ischium, 100, 101.

( d ) Gunshot fracture, 105.

VII.— Fractures and Dislocations of the Bones of the Lower Extre-
mity— i

(a) Fractures of the femur, neck, intra-capsular, 106, 107, 108 109

110, 111, 112, 113.

(b) —

(r\

, extra-capsular, 112f, 114f, 115,
116f, 117, 1 18f. 119, 120.

\C>

, snaic, upper end, 121, 122, 123f, 124.

/ r \ (B

, l, ±60], 160, ±6/, lJoT*

129f.

[C)

ino iciiiu.1 oj-itij.L, lower end, loUj, iol, 133

134f, 135f, 136f, 137f, 138.

V )

(g)

loth bones of the leg, 143, 144f, 145f, 146, 147.

148, 149, 150, 151, 152, 153, 154f, 155, 156,
157, 158, 159, 160, 161.

SERIES I.]

FRACTURES AND DISLOCATIONS.

(h) Fractures of the tibia, upper end, 163, 164.

(y;) , central part, 165, 166, 167. 168.

(j) , lower end, 169. 170, 171, 172.

(ic) fibula, 173+, 174f, 175f, 176, 177.

(A bones of the tarsus and metatarsus, &c., 178,

179, 180, 181, 182.

(m) Multiple fracture of bones of the lower extremity, 189.

( n ) Dislocation of the hip-joint, 183.

(o) . knee-joint, 184.

(p) ankle-joint, 151, 185, 186, 187, 188.

\q) Gunshot injuries to bones of the lower extremity, 139, 140f, 141,
142, 162.

(r) Fractures and other injuries of bone in the lower animals, 190,
191, 192, 193, 194, 195, 196.

B.— SURGICAL : SHOWING THE KIND OF FRACTURE, ITS COURSE, AND ANY

COMPLICATIONS.*

Compound fractures, 69, 71, 74, 75, 76, 77, 83, 84, 85, 86, 87, 91, 146,
148, 149, 151, 156, 164, 165, 169, 170.

dislocations, 148, 151, 156, 184, 185, 186, 187, 188.

Fractures of Long Bones —

Transverse, 79, 88, 143, 150, 157, 165, 168.

Vertical, 155, 160.

Oblique, 121, 123, 124, 125, 128, 129, 130, 134, 136, 137, 144, 159, 163,
171, 173, 174, 175, 176, 177.

Comminuted. 69, 72, 73, 78, 80, 82, 89, 90, 92, 109, 118, 122, 131. 133,
135, 136, 138, 139, 140, 141, 145, 147, 153, 158, 160, 162, 167, 172.
Impacted, 114, 116, 118.

Incomplete, 160, 168.

Fractures of Flat Bones —

Starred, 11.

Linear, 6, 23, 25, 26, 28.

Comminuted, 1, 11, 19, 20, 21, 22, 25, 27, 63.
Depressed, 5, 7, 8, 10, 11, 12, 18, 19, 21, 22.
Depression of inner table only, 3, 4, 11.
Perforating or punctured fracture, 13, 16, 17.

Fractures of Cuboid or Irregular Bones —

Single, 34, 39, 40.

Comminuted, 37, 41, 52, 56, 66, 102, 105, 178, 179. 180, 181, 182.
Gunshot injuries, 31, 32, 58, 59, 82, 97, 98, 105, 139, 140, 141, 142,
162.

Sword injury, 24, 60, 67.

* Does not include all the specimens, but sufficient to be
specified.

illustrative of the conditions

FRACTURES AND DISLOCATIONS.

[SERIES I.

SURGICAL COMPLICATION S.

Fractures into Joints —

Hip, 106, 107, 108, 110, 112, 113, 141.

Knee, 132, 133, 136, 138, 153.

Ankle. 145, 146, 148, 151, 155, 156, 172, 175, 176, 177.
Shoulder, 69.

Elbow, 73, 78, 79, 80.

Wrist, 85, 86, 89, 90.

Injuries of neighbouring parts in Fractures and Dislocations, viz. —

Laceration of brain or membranes. 11, 14, 15, 16

of spinal cord or membranes, 36, 38, 40, 41,42, 44,45,

46, 47, 48, 49, 54, 57, 59.

of blood-vessels, 2, 6, 8, 16, 20, 22,

of viscera, 100, 101.

Periosteum holding fragments together, 62, 88.

Separation of epiphyses, 161, 184, 188.

Injuries necessitating amputation. 69, 71, 75, 76, 77, 79. 80. 82, 83,
90, 93, 135, 136, 138, 139, 141, 150, 151, 152, 153, 155, 156, 157,
158, 160, 161, 162, 167, 168, 172, 175, 176, 179, 180, 181, 182,
184, 188,

Trephining, 1, 8, 10.

Craniotomy, results of, 33a.

Fragments of bone removed in compound fracture, 81, 142.

C.— PATHOLOGICAL : showing the state of union of frac-
tures, &c.

Union by fibrous tissue, 116, 137.

by bone ensheathing the fragments, 61, 64, 67, 93, 112, 118.

inlaid between the fragments, 3, 53, 65, 114, 123,

125, 128, 129, 134, 144, 174, 175, 189.

forming bridges between the fragments, 130, 132, 135,

136, 140, 145, 154, 173.

State of the Medullary Canaj, —

Filled up by bone, 129, 130, 134, 144, 154.

partially by bone, 123, 125, 136, 189.

up by fibrous tissue, 137.

Union of two bones of a limb together, 144, 145, 154.

False-joint after fracture, 106.

Necrosis after simple fracture, 131.

compound fracture, 80, 135, 149, 150.

TTnunited fractures, 110, 111, 112, 113, 122, 149, 163, 189.

Eepair of fractures in the lower animals, 191, 192, 193, 194, 195.

series i.] FRACTURES OF THE SKULL. 5

1. Extensive fracture of the bones forming the superior region

of the skull, with diastasis of the coronal, sagittal, and
lambdoidal sutures. “The subject of this was Private John
McDougall, aged 27 years, resident in India five years, stout,
and of sober habits. The injury was the result of a fall from
his horse. Was admitted into hospital in a partially insensible
, condition ; could not answer questions, but pointed to his head
as the seat of injury. Pupils dilated ; pulse slow and inter-
mitting ; respiration laborious; countenance pale; skin warm.
There is a mark of contusion on centre of parietal bone. On
examination there appears to be a fracture across the occipital
bone, with effusion beneath the scalp. He is very restless, and
threw up about four ounces of coagulated blood. No haemor-
rhage from nose and ears. The patient became gradually more
and more insensible, the breathing stertorous and slow, and he
expired about an hour after the receipt of the injury. On
post-mortem examination, an immense quantity of dark-coloured
blood was found extravasated beneath the scalp, an extensive
fracture of the occipital bone, the lines intersecting each other,
and extending into both parietal bones, and running down the
frontal bone into the left orbit. The left half of the coronary,
the sagittal, and occipital sutures were entirely separated.” The
occipital bone seems to have been trephined, and the circle of
bone thus removed is preserved with the skull, but there is no
reference to this operation given by Dr. Mouat (H. M.’s 15th
Hussars, Bangalore, 26th February 1816), whose description of
the case is above quoted.

2. Fracture of the external and internal tables (the latter being most

extensive) of the left parietal bone, just over the situation
of the middle meningeal artery, and complete diastasis of the
coronal suture. From a native dacoit. (Ewart.)

3. Fracture transversely across the whole of the right, continued

inches into the left parietal bone, with depression of
the inner table. The fracture of the outer table of the left
parietal bone has been repaired by bony union, and part of that
in the right parietal has been all but bridged by osseous tissue.
A good deal of new bone has also been deposited around the
depressed portion of the inner table. (Ewart.)

4. “Calvarium of a European sailor, killed by lathi blows in the

Akyab bazar, showing violent loosening of the coronal suture,
ot part of the longitudinal, and slight fissures in the left
parietal and corresponding part of the frontal bone.” The
inner table of the former is slightly depressed. “ The patient
lived two days.” ( Presented by Dr. Mountjoy of Akyab.)

5. Calvarium of a European sailor, who was killed by "falling from

the main deck of a vessel down to the hold, upon stone
ballast, showing fracture of the occipital, and fracture with
great depression of a portion of the left parietal bone, measuring
lour inches by two. The bone is driven in cleanly. Patient
survived six days. There was perfect paralysis in all nerves below

FKACTUKES OF THE SKULL.

[seeies r.

the origin of the pneumogastric. (Ewart.) Portions of the
lambdoid and sagittal sutures have separated as a direct result
of the injury. (Presented by Dr. Mountjoy of Akyab.)

6. Skull of a native, showing a clean linear fracture running obliquely

across the right temporal bone, just above the superior root of
the zygoma. The principal fracture, however, is on the left side,
through the frontal, across the anterior superior angle of the
parietal, and through the sagittal suture, to near the posterior
superior angle of the right parietal. There is an opening made
by the trephine a little below the line of fracture in the left
parietal. The latter, it will be observed, crosses the groove for
the posterior bifurcation of the middle meningeal artery, and
this vessel was probably severed, as a large quantity of extra-
vasated blood was found at the base of the skull, “ pressing upon
the medulla oblongata.” ( Presented by Professor Allan Webb.)

7. A portion of the parietal bone, showing fracture and depression of

the inner table. (Ewart.) {Presented by Professor Allan Webb.)

8. Calvarium of a native admitted into hospital, with a depressed

fracture in the left temporal region, and with symptoms of
compression. The depressed bone was elevated after the appli-
cation of the trephine, but death occurred notwithstanding,
within 48 hours after admission. The preparation shows the
aperture made by the trephine, and the remains of the fractured
surface. The elevated fragments are, however, wanting, and also
much of the inner table immediately below the seat of injury.
The latter is at the anterior border of the left parietal bone, one
inch below the point of junction of the sagittal with the left
half of the coronal suture. The fracture was apparently much
comminuted, involves the adjacent portion of the frontal bone,
and is continued downwards in a linear form towards the
anterior inferior angle of the parietal. It thus divides several
grooves for the lodgment (on the inner surface of the skull) of
branches of the middle meningeal artery, and was, as a fact,
associated with much intra-cranial haemorrhage and brain-com-
pression therefrom. The fracture has the appearance of having
been inflicted by a blunt, but heavy, instrument. The bones of
this skull generally are unusually thin.

9. Fracture of the right parietal bone, and separation of the coronal

suture, with exudation of lymph on the surface and between the
membranes of the cerebrum, the consequence of a fall. (Ewart.)

10. Calvarium of a native girl, showing two incomplete, hourglass-

shaped trephine-holes, situated just above the left parietal
eminence, and over a linear fissure with depression of that bone
(left parietal). Trephining was performed on account of rigors
supervening a few days after receipt of the injury, although the
patient had never lost consciousness. On removal of one circle
of bone, the inner table, just beneath the fissure in the external
table, was found extensively depressed, and about half a drachm
of laudable pus escaped from the opening. A second incom-
plete circle had to be removed before the whole of the depressed

8EBIES I.]

FKACTUKES OF THE SKULL.

11.

12.

13.

14.

15.

bone could be elevated. The dura mater then bulged into the
opening ; its surface was seen to be covered with lymph and pus,
and the diploe infiltrated with the same. The patient
ultimately succumbed to acute cerebrc-meningitis. The surface
of the left hemisphere of the brain (corresponding to the injury)
was found coated with purulent exudation at the post-mortem
examination.

Comminuted, depressed fracture of the skull. “ The left parietal
bone is literally smashed to pieces over a surface about seven
inches in circumference at its inferior part. There are seven or
eight fragments, all of which are more or less depressed ; but at
the upper part the depression is abrupt, at the edge of the sound
bone, to the extent of very nearly half an inch. A long open
fissure extends from the smash to the inferior posterior an^-le of
the bone. On the centre of the forehead there is a starred

fracture, depressing the fragments of the internal plate one-
eighth "" ’--U . ji . - 1

°^. an inch ; and at the superior posterior angle of the

right parietal bone there is an excellent example of a
depressed fracture of the inner table alone, there not beino- the
slightest mark externally on the skull, but at the post-mortem
examination there was an incised wound of the scalp penetrating
to the bone at a corresponding position. A considerable amount
ol blood was extravasated in the position of the smash both
ff°n and beneath the dura mater, which had been penetrated, but

■i edCl^ aTfU!f ia ^ u?injured” From a native boy,
and fi; He W. a,/Juan;el with a man about some mangoes
and the man battered m his (the boy’s) skull by means of a

Thee bovT ar <!Uarte ab°Ut the 8ize of an in&nt’s hell.

. . boy became comatose immediately upon receipt of Ihc

S.bj JZt mr2s hT< W,. *22?

cr-t. tsz

8 FRACTURES OF TIIE SKULL. [sebies i.

broad. (Ewart.) No history. ( Presented by Professor Allan

Webb.)

16. The vault of the skull from a native male subject in the dissecting-

room, showing perforation of the same by a slender iron nail.
A small opening is seen in the frontal bone in the mesial line,
about an inch above the frontal sinuses. The inner opening is
in the longitudinal sinus. A glass rod indicates the exact
situation. There is an old cicatrix in the skin of the forehead
corresponding to the injury in the bone below, and on dissecting
this off the pericranium is seen, also thickened and slightly
depressed or puckered over the small aperture. The nail was
found fixed thus at one end to the bone, the other lying free
in the longitudinal sinus. ( Presented by Assistant Surgeon

Chunder Mohun Ghose.)

17. Calvarium of a Mahomedan female, aged 40, who fell from a

height of 12 feet on to her forehead, and was brought into the
hospital in a state of insensibility. A compound punctured
fracture of the frontal bone in the median line was found, with
considerable depression of the inner table. An oval-shaped
aperture is seen in the preparation, representing the state of
parts after elevation of the depressed fragments. It is rather
larger than an eight-anna (shilling) piece.

18. A depressed fracture of the frontal bone, situated a little below

and to the left of the corresponding frontal eminence. A
rounded aperture is seen in the outer table, about the size of an
eight-anna (shilling) piece. Three large fragments of this table
are much depressed, and the inner table to even a greater extent.
The skull generally is remarkably thin. The fracture was
produced, it is believed, by a blow from a “ dhao.”

19. Calvarium of a native (Hindu, male), aged 25. Exhibits exten-

sive transverse fracture with depression, caused by a l>rick cornice
from a two-storied house falling on his head. There are three
transverse fractures of the frontal bone (the posterior involving
also the left parietal) — two of which include between them an
oval piece 7\ inches in circumference, 3 inches in breadth, and 2
inches in length, which is much depressed. (Colles.) On the left
side the fracture extends along, and partially involves, the
coronal suture, approaching the base of the skull.

20. Extensive fracture of the bones of the left side and base of the
skull and face, viz. of the malar, nasal, nasal process of the superior
maxillary, condyloid process of the lower jaw, and of the tem-
poral, and inferior and anterior part of the parietal bones, leading
to rupture of the middle meningeal artery. In the temporal the
fracture is comminuted, and the alar is separated from the
mastoid portion of the bone, and the petrous portion also trans-
versely fractured. Further, there is a fracture of the occipital,
complete separation of the petro-occipital articulation ; fracture
of the body of the sphenoid, and comminuted fracture of the
orbital plate of the same. (Ewart.) The subject, a Hindu labourer,
fell into a pucca drain while carrying a heavy load of sugar,

SERIES I.]

FRACTURES OF THE SKULL.

and thus sustained all these injuries. He was brought to the
hospital quite insensible, but recovered consciousness, and was
even able to sit up and answer questions alter an interval of
about 12 hours. This, however, was quickly succeeded by ie-
current insensibility, stertorous breathing, with dilated pupils,
and gradually advancing coma, and he died about 29 hours after
the accident. At the post-mortem examination “the left middle
meningeal was found torn through, and a large quantity of
blood extravasated between the dura mater and brain, imme-
diately opposite the temporal region.”

21. A portion of the left side of the skull, showing a fracture running

obliquely across the upper part of the temporal fossa, extending
from the external angular process of the frontal to about an
inch in front of the temporal ridge of the temporal, with a
large oval piece, completely separated and depressed. It is com-
posed of the anterior inferior angle of the parietal, and of
that portion of the frontal which enters into the construction
of the temporal fossa. The line of fracture also passes in-
wards from the external angular process across the orbital
plate of the frontal, and the cribriform plate of the ethmoid
to the median line, the bone all along this line of fracture being
comminuted. The patient, a native coachman, received a kick from
a horse. He was brought to the hospital in an insensible condi-
tion. There was a wound about an inch and a half in length at
the upper and anterior part of the left temporal region ; profuse
bleeding from the nose ; great ecchymosis and swelling of the
ocular conjunctiva and eye-lids, with dilatation of the left pupil ;
and the breathing was stertorous. The oval depressed portion of
bone could be felt when the finger was introduced into the
wound. It was elevated, and almost immediately the stertor
stopped. The patient, however, remained insensible ; right hemi-
plegia soon supervened, and he died on the third day after
admission.

22. Extensive fracture of the occipital and parietal bones, with depres-

sion of some of the fragments, separation of the sagittal suture,
and wound of the longitudinal sinus, a little above the Torcular
Herophili. The wound is marked by a glass rod in the prepa-
ration. A large coagulum was found between the brain and dura
mater, the blood having passed through a rent in the latter
below the left lateral sinus. This is also indicated by a glass
rod. The patient, a woman, was found murdered. (Colies.)
( Presented by Dr. R. T. Lyons, 20th P. N. I., Rawal Pindi.)

23. Calvarium of an adult Musalman, who was brought in (to the

hospital) insensible, having fallen from a height of twenty feet.
He died six hours after admission. There is separation of the
posterior third of the sagittal suture, and from the point of
junction of the latter with the lambdoid suture, a fracture
extends downwards and to the right, through the squama occipitis.
It reached the foramen magnum, but the base of the skull was
not obtained. (Colies.)

FRACTURES OF THE SKULL.

[SEKIES I.

24. A portion of the skull, showing the result of a sword-cut in the

occipital region. About two-thirds of the external lamina of the
occipital bone, with a portion as large as a half-crown piece of its
whole thickness, have been removed, laying bare the diploe, and
producing a perforation, which occupies the inner two-thirds of
the right cerebellar fossa. The margins of this opening are sharp
and abrupt ; those of the cut through the external table, bevelled
off and smooth. The slice of the occipital bone removed by this
sword-cut was found in the flap of the severed scalp, and mea-
sured seven inches in circumference. Through the opening
in the skull a hernia of the cerebellum protruded during life.
No loss of consciousness, but peculiar “jerking” of the limbs
ensued immediately upon the receipt of the injury ( i.e . loss of
co-ordinating power). On the fourteenth day symptoms of
stupor supervened, which gradually deepened, and the patient
died comatose on the eighteenth day.

At about the centre of the right parietal bone, running parallel with
the sagittal suture, is another sword-cut in the bone, two
inches in length and one-fourth of an inch deep. It has passed
through the external table of the skull, exposing the diploe,
but does not penetrate. — From a native woman, who was
attacked by her husband with a sword with the view to
decapitation. ( See further Indian Medical Gazette, January 3rd,
1875, p. 7.) ( Presented by E. A. Birch, Esq., f.k.c.s., &c.,

Civil Surgeon, Hazaribagh.)

25. Extensive fracture of the base of the skull, involving all three

fossae. The following are the more important injuries : — (1) a
fracture through the whole length of the petrous portion of the
right temporal bone, opening into the external auditory meatus ;
(2) a separation of the apex of the petrous portion from the rest
of the temporal bone (right) ; (3) a fissured fracture, extending
obliquely backwards and inwards from the posterior lacerated
foramen to the foramen magnum, passing completely through
the occipital bone just behind the right condyle ; (4) a vertical
fracture through the left margin of the foramen magnum
immediately above the left condyle, but only partially involving
the latter ; (5) a comminuted fracture of the right lesser
wing of the sphenoid and adjacent portion of the orbital
plate of the frontal bone. — From a European soldier, A. W.,
aged 28, who fell into the street, while drunk, from the
second story of a tavern, and was brought to the hospital
perfectly insensible, cold, and collapsed. “ No external wound
could be detected, but there was oozing of blood from the
right ear.” After an interval of about four hours, he partially
regained consciousness, and was able to answer questions put
to him relative to his name, age, occupation, the accident,
&c. In twelve hours’ time he was quite sensible. “ Complained
of severe pain in the head, right shoulder, and arms;”
was restless and irritable. Paralysis of the right side of

the face was now noticed. On the following day was still

sensible, “ thirst urgent ; stomach irritable ; exceedingly rest-

SERIES I.]

FRACTURES OF THE SKULL.

1 1

less towards evening drowsy. This last symptom gradually
increased, and he died comatose on the fourth day, or 89
hours after the receipt of this very severe injury.

26. A portion of the right side of the skull, showing a linear fracture

or fissure through the middle of the petrous portion of the
temporal bone, extending from the jugular fossa posteriorly,
across the superior surface of the bone, to the groove leading
to the hiatus Fallopii on its anterior surface. The fracture
is distinctly seen to communicate with the auditory canal.
No history.

27. Fracture of the skull, affecting chiefly the base. In the left

middle fossa there is seen a transverse fracture running along the
anterior surface of the petrous portion of the temporal bone,
separating it from the great wing of the sphenoid, and being a
direct continuation of a vertical fracture through the middle of
the squamous portion of the left temporal bone. This fracture
opens into the auditory canal, and completely separates the
Glaserian fissure. The vertical fracture above indicated has a
transverse fissure running forwards from it, about two inches in
length, through the squamous portion of the temporal, three-
fourths of an inch above the zygoma. Returning to the base of
the brain, there is a complete transverse fracture of the body of
the sphenoid immediately behind the sella Turcica, and linear
fissurings of the right and left' orbital plates of the frontal bone.
The patient, an aged Hindu, was said to have been “knocked
down by the shaft of a buggy coming forcibly against his person
while being furiously driven through the streets.’’ He was cold
and collapsed, but not quite insensible when brought into the
hospital. The breathing was oppressed, but not stertorous, and
he could answer questions when put in a loud voice. There
was oozing of blood from the left ear. Gradually insensibility,
with stertorous breathing and paralysis of the left side of the
face, supervened, but the patient lived for a little over <30 hours
after the receipt of these severe injuries.

28. Fracture of the base of the skull “ caused by a blow of the fist.”

(. Presented by Professor J. Fayrer, M.D., &c.) No other history
preserved. The fracture extends through the right half of the
occipital bone, and across the entire thickness of the petrous
portion of the right temporal, commencing near the right
middle lacerated foramen. It is traced backwards across the
petrous portion of the temporal, the right jugular fossa, lateral
sinus, and cerebellar fossa, and then upwards and inwards to
terminate in a linear Assuring onlv of the inner table at the

O %/ f f

lambdoid suture, a little to the right of the junction of the latter
with the sagittal suture.

29. A vertical fracture through the body of the lower jaw of a child,

on the right side. The line of fracture passes just in front of a
bicuspid tooth, which can be seen in the alveolar wall, but has
not yet passed through it. There is also an L-shaped fissuie on
the inner side of the coronoid process, almost detaching it from
the rest of the bone.

FRACTURES OF THE SKULL.

[series I.

30. Fracture of the right side of the lower jaw of an adult. Tiie
fracture is situated at the junction of the ascending with the
transverse ramus, and is directed from above (just behind the last
molar) downwards, and a little obliquely outwards, through the
whole thickness of the hone.

31. Calvarium of Mrs. A. A. M., aged 17, an Eurasian, killed by

the discharge of a gun loaded with small shot. She died
hours after being wounded. The right side of the frontal bone,
above the outer angle of the eyebrow, is marked by a number
of small shot, of which only three have penetrated. Their
tracks are united by fractures, and the piece of bone thus
isolated has fallen out. Another grain of the shot has pene-
trated near the posterior margin of the frontal bone, and a
long fracture extends backwards from it, through the parietal
hone, following one of the branches of the middle meningeal
artery. (Colies.)

32 The anterior part of the skull of Garrett Rouke, Her Majesty’s 18th
Regiment, who was shot through the head in the attack on the
Great Pagoda of Rangoon. The bullet (a rounded leaden one)
entered just behind the left frontal eminence, where the skull
has been trephined, and is now lodged where it was found, after
having made a tolerably clean hole (without any comminution
of surrounding hone) in the inner side of the orbital plate of
the right side. At the orifice of entrance the margin of bone
is irregular externally, and internally a portion of the inner
table is depressed. (Ewart.) A linear fracture or fissure
through both tables extends from the lower margin of the
trephine hole downwards and inwards to the superciliary ridge.
(. Presented by Dr. J. Fayrer, Field Hospital, Rangoon.) .

33. Extensive fracture of the vault of the skull from lightning.
Commencing with the left parietal region, there is a bevelled
fracture running upwards and backwards from near the anterior
inferior angle of the parietal to the posterior third of the
sagittal suture, across the latter into the posterior superior
angle of the right parietal, and downwards along the posterior
margin of that hone to end near the centre of the right half of
the lamhdoid suture. Meeting this fracture near the posterior
superior angle of the right parietal is a second linear fracture
completely through the hone, and which may he traced from
this point transversely across the right parietal, the right half of
the coronal suture, and into the frontal bone, terminating just
above the superciliary ridge. A third fracture is seen in the right
parietal, from its anterior superior angle (at the sagittal suture)
downwards and backwards to join the second fracture above
described, just above the right parietal eminence. All the bones
forming the vault of the skull are unusually thin. ( Presented
by Assistant Surgeon Udi Charn Datta.)

33a. Foetal head from a case in which craniotomy was performed on
account of contraction of the pelvic outlet, showing the exten-
sive injuries inflicted upon the hones of the vault and base by
the perforator. The bones chiefly broken up are the left parietal,

SERIES I.]

FRACTURES OF THE SPINE.

the occipital (at the posterior fontanelle), the left temporal and
malar, and the sphenoid.

34. Fracture of the odontoid process of the axis, the result of a tall

from the top of a house, followed by instant death, hiom a
native female. (Ewart.)

35. Fracture of the fifth and sixth cervical vertibr®. The fracture is

directed from above downwards and a little to the left, passing
completely through the bodies of both vertebrae. No history. _

30. Fracture of the rings of the first, second, and third cervical
vertebrae, displacement of the second from the third, with rupture
of the intervertebral substance, and laceration of the cord and
membranes. (Ewart.)

37. A comminuted fracture of the fifth cervical vertebra, with dis-

placement forwards and a little to the left of the lower portion
of the spinal column. The intervertebral cartilage between the
fifth and sixth vertebrae is ruptured. The membranes ol the cord
are entire, but the latter must have been compressed opposite the
seat of injury. No history.

38. T ransverse fracture of the body of the sixth cervical vertebra,

and a vertical fracture of the left lamina of the fifth cervical.
“ The pia mater of the cord to the level of the second dorsal
vertebra was found a good deal congested, and the cord itself in
the neighbourhood of the fracture softened and compressed.” —
Case of a native (male), Cheytun Das. The injury was produced
by the fall of a bag of rice, weighing two maunds, upon the upper-
part of his spine.

39. The cervical portion of tire spine and the first two dorsal vertebrae,

with the whole of the cord. From a native (male) patient,
aged 45. There is a transverse fracture of the fourth cervical
vertebra, -with forward displacement of the cervical spine, and
consequent pressure and injury to the cord. The patient died a
few hours after the accident.

40. Transverse fracture of the body of the sixth cervical vertebra,
with displacement forwards of the upper cervical vertebrae, and
compression of the cord. The anterior common ligament is
ruptured. — From a Hindu cooly. The injury resulted from the
fall of a heavy sack of rice on the back of his neck. “ The
sternum of this patient was found also fractured between the
second and third costal cartilages ; and as there was no external
mark of injury in the thorax, it is presumed that the bone must
have given way in consequence of the sudden doubling forwards
of the chest when the weight descended upon the neck.

“ On admission the patient had still some slight power of motion in the
upper extremities, but the rest of the body was paralysed. He
lived for eight or nine hours.” (Colies.)

41. The cervical portion of the spine, showing fracture of the fourth

vertebra. The body is completely broken from behind forwards,
and the spinous process, with parts of the lamina), separated.
The patient, a native cooly, wdiile carrying a heavy load on his
head, accidentally fell forwards ; the load slipped on to the back
of his neck, causing powerful flexion of the spine and consequent

FBACTUKES AND DISLOCATIONS

[semes I.

fracture. "When admitted into hospital there was much swelling-
of the soft parts at the back of the neck, and complete paralysis
both of motion and sensation of the trunk, upper and lower
extremities. The respiration was entirely diaphragmatic. The
intellect remained unaffected. He survived the injury 59 hours.
The spinal cord was found, post-mortem , extensively crushed.

42. Fracture and dislocation of the cervical portion of the spine. The

upper portion of the right superior articular process of the
fifth vertebra is fractured and detached ; and in consequence of
this, the inferior articular process of the fourth vertebra is
thrown forwards and inwards. The left inferior articular process
of the fourth has glided backwards, and its transverse process
become approximated to the left superior articular process of
the fifth. The capsular ligaments on both sides were torn.
The anterior ligament was unfortunately cut away at the
post-mortem examination. The injuries above described contri-
buted to the twist of the upper part of this portion of the spine
upon the lower.

The patient, a Mahomedan coachman, fell head foremost from his seat
on the box on to the carriage wheel below, and then to the
ground. He was brought into the hospital completely paralysed,
and the respiration purely diaphragmatic. He was also quite
insensible, but yawned occasionally, and there were other indi-
cations of motor power in the muscles of the face. He survived
about seventy hours.

43. Fracture of the fifth and sixth cervical vertebrae. The body of the

fifth is broken transversely, and the laminae separated from the pedi-
cles. The body of the sixth is partially fractured. The patient
(a native) was picked up in the street drunk and paralysed,
and brought thus to the hospital. He had no recollection of
any injury, and no history of the same could subsequently
be ascertained. There was complete paralysis of the trunk,
lower extremities, and left arm. Slight power of movement
in the right upper extremity. The respiration was not entirely
diaphragmatic ; the intercostal muscles of the right side
appeared to work. Both sensation and motion were normal
in the head and face. The patient could talk rationally (after
recovering from his drunken condition), could whistle, and
slightly raise his head. He complained of much pain at the
lower part of the neck.

44. Fracture with displacement of the cervical portion of the spine.
The subflavian ligament between the seventh cervical and first
dorsal vertebra) is torn through, as also the inter-transverse,
inter-spinous, and supra-spinous ligaments. The lamina) of
these vertebrae are widely separated. The lower edge of the
left articular process of the seventh cervical is chipped off, and
the whole of the cervical portion of the column seems to be a
little twisted from right to left, forwards and inwards, upon the
dorsal vertebrae. The cord at the seat of injury was found deeply
injected and softened.

SEEIES I.]

OF THE SPINE.

The specimen is taken from a Hindu coachman, aged 30. While driving,
he accidentally fell off, alighting on the back of his neck, the head
being thrown violently forwards. When brought into hospital a
fracture could distinctly be felt at the lower cervical region of the
spine, and the patient was paraplegic. Loss of sensation reached
to the level of the nipples; above which line it was imperfect,
but normal over the face, head, and upper extremities ; he could
also move his arms. The respiration was almost entirely abdo-
minal, the chest-walls moving but slightly.

45. Fracture of the fifth and sixth cervical vertebrae. The fifth ver-

tebra has a fracture passing vertically through the whole thick-
ness of the body, so as to divide it into two equal portions.
The sixth vertebra is fissured from above downwards, a little to
the left of the median line, through nearly the whole thickness
of the body, but not reaching the anterior surface. It is best
seen from behind, where the laminae were removed post-
mortem in order to expose the cord. The latter was lacerated,
indeed, almost completely and abruptly severed opposite the
fracture. — From a European seaman, who, while partially intoxi-
cated, jumped head-foremost off one of the jetties into the
river for the purpose of bathing, the water at this spot being,
however, only about a foot and a half deep.

On admission into hospital there was a large contused wound on the
vertex of the skull ; the pupils slightly contracted ; respiration 48,
diaphragmatic ; was quite conscious, but restless, and complained
of pain at the back of the neck. There was complete paralysis
of both motion and sensation in the lower extremities and lower
half of the trunk. No reflex movements of the limbs elicited by
tickling the soles of the feet. No paralysis of the upper
extremities. No priapism.

Was admitted at 7-30 p.m. on the 23rd September 1S77 ; at 8-30 p.m.
the temperature was 100°'2 ; at 10 p.m. 101o,4; at 1a.m. 104o,2.

24th September, 7 a.m. Temperature 105o,4 ; breathing laboured ; patient
quite unconscious.

3 p.m. Temperature in the axilla 107° ; in the rectum 107o,2 ; of
lower extremities 101O-6.

9 p.m. Temperature in axilla 106 3 G ; of lower e xtremities 101o,8.
Breathing very difficult and pulse very frequent.

3-30 a m. (25th September.) Respiration stertorous ; no pulse ; died
at 3-50 a.m., i.e, about 44 hours after admission.

46. Dislocation forwards of the fifth cervical vertebra, with rupture of
the intervertebral cartilage between it and the sixth vertebra.
The opposed articular processes of the fifth and sixth vertebrae
are seen separated ; the capsular ligaments ruptured. The cord
is exposed behind, and shows softening and compression opposite
the displaced vertebra. No history.

47. “ Cervical vertebrae of Kessub Dass, admitted into hospital with

what was supposed to be spasmodic contraction of the anterior
muscles of the neck, flexing the head permanently forwards.
The next day chloroform was administered, and the head

16 FRACTURES AND DISLOCATIONS [series i.

extended. The patient became pale and depressed, and died in
five hours.”

The intervertebral substance has separated from the under surface of
the body of the fifth cervical vertebra, and is much torn where
still adherent to the sixth, “ and the ends of the articular and
spinous processes of both these vertebrae are broken off. The
anterior common ligament, if not the posterior also, had been
ruptured before death. There was some ecchymosis of the
muscles surrounding this portion of the spine. There appeared
to be no deformity of any of the vertebrae.

“ The spinal cord opposite the point of fracture was slightly softened
and constricted, and the pia mater was slightly injected. Under
the microscope this portion of the cord did not show anything
abnormal.” (Colies.)

48. A dry preparation of a case of spinal luxation, high up in the

cervical region, resulting in paralysis of both upper and lower
extremities, and terminating in death on or about the twelfth
day.

Bhoot Nath, a Hindu cooly, aged 25, was carrying a heavy log of
wood on his head together with another fellow-labourer, who,
letting it fall off' his own head, caused a sudden backward, forcible
jerking of the patient’s head and neck, and the latter is then
said to have immediately fallen to the ground, “ losing all
power and sensibility in his limbs. He remained at home
in this state for about five days, but was brought to the hospital
on the 17th June 1870. There was an unusual hollow at the
back of the neck, but no crepitation or lateral flexion detected.”
The bladder was paralysed, and the rectum partially so. “ He
remained quite conscious up to the 21st, when he became
delirious, the breathing laboured and entirely diaphragmatic,
and he died on the 23rd June.”

On post-mortem examination there was found rupture of the anterior
common ligament, with displacement forwards of the intervertebral
substance between the third and fourth cervical vertebrae. The
cord was greatly compressed, almost cut through at this portion
of the spine. Its substance softened, so as to wash away on
pouring a stream of water over it. No fracture could be
detected.

[In the dry preparation preserved, the spinal canal has been opened
from behind, the spinous processes and laminae of the vertebrae
being cut away. This renders the specimen less interesting and
reliable, inasmuch as it is hardly possible to understand how so
complete severing of the cord could take place without fracture. —
J. F. P. McC.]

49. Dislocation forwards of the cervical spine. The fifth interver-

tebral cartilage, i.e. that between the sixth and seventh cervical
vertebrae, has been ruptured, as also the anterior common ligament
and the capsular ligaments. No fracture appears to have taken
place. A large extravasation of blood was found at the site
of the luxation, both external to the dura mater and within that
membrane. It reached downwards as far as the last dorsal

SERIES I.]

OF THE SPINE.

vertebra, and extended upwards into the skull. The cord at
the seat of injury was completely compressed.

The man from whom this preparation was taken was a European,
aged 41, an officer of the S. S. City of Boston. He was on shore
with some friends, and while in a semi-intoxicated condition fell
out of a window, 18 feet from the grouqd, on to his back. He
appears to have become insensible for a short time. When
picked up, about twelve hours after the accident, he was found
completely paralysed ; and in this condition was brought to
the hospital. Besides complete paralysis of the upper and
lower extremities, and of the trunk from the hips to the level
of the nipples, the breathing was diaphragmatic, and the
patient loudly complained of pain at about the level of the first
dorsal vertebra. The skin was intensely hot and pungent ;
temperature 106° Fahrenheit ; the pulse incompressible, full, and
bounding.

He was bled to 16 ounces, and appeared to be much relieved thereby,
but after a few hours became drowsy and confused, and this
gradually deepened into coma (probably as the extravasation
into and around the cord at the seat of the injury extended
upwards to the medulla and base of the brain), and died eighteen
hours after admission.

50. Fracture of the spinous processes and lamime of the last dorsal
vertebra, with rupture of the intervertebral fibro-cartilage
between it and the twelfth vertebra. The anterior and posterior
common ligaments have been completely torn through. The
upper part of the spinal column is displaced downwards, forwards,
and to the left— upon the lower. The termination of the cord is
greatly compressed and flattened, but the membranes were found
entire (unruptured). — From a native (male), aged 50, upon
whose back a bag of pepper, weighing about two mannds, acci-
dentally fell. There was complete paraplegia, with loss of power
also, over the bladder and rectum. The anaesthesia extended as
high up as the middle of the abdomen.

51. F racture of the spine. The preparation exhibits a very severe

comminuted fracture of the eleventh dorsal vertebra. The
anterior compact lamina of the body of this vertebra has been
broken into several fragments, and a vertical fracture extends
through the whole thickness of the body, a little to the right of
the median line. This presents a mere fissure anteriorly, but is
wide, and the fragments much displaced posteriorly. The right
articular process has also been completely separated. (The
lamina? have not been preserved.) Around and over the frac-
tured bone traces of reparative action, i.e. new osseous deposit,
are observed, showing that the fracture was of some standing,

The subject was a native (male), aged 40, and the fracture was produced
by the fall of a heavy bale of jute upon his back. There was no
external injury. (Presented by the Police Surgeon.)

52. Comminuted fracture of the third, fourth, and fifth lumbar

vertebra?, with considerable displacement of the fragments. No

FRACTURES AND DISLOCATIONS

[series I.

53. Transverse fracture of the body of the first lumbar vertebra, with

displacement forwards and to the right of the upper upon the
lower portion of the vertebral column. The cord is compressed
just at its termination in the cauda equina. Firm bony union
is seen to have taken place between the fractured fragments.
{Presented by Professor Allan Webb.)

54. “ Spinal column of a patient named J. Stone, aged 25 years,

admitted with paraplegia on the 9th April, and died on the 27th
May 1866. There is a transverse fracture across the body of
the first lumbar vertebra.” At the seat of fracture the “ c6rd was
found almost completely torn in two.” “Both above and below
this point there was considerable softening ; in an upward direc-
tion this extended as far as the tenth dorsal vertebra.” (Ewait.)

55. Transverse fracture of the first lumbar vertebra, with laceration

and rupture of the intervertebral cartilage between it and the
last dorsal, and dislocation backwards of the upper portion of the
spine at the level of the injury. The cord was found “ slightly
softened and congested a little above the injury.” — From a
native male, aged 35, who fell from a considerable height, and
fractured, at the same time, his right os calcis.

56. Preparation showing an oblique fracture of the body and laminae

of the third lumbar vertebra, as well as fracture of its right
transverse process. The spine of the third lumbar vertebra
was found in its natural position, the spine and body of
the fourth vertebra, as well as the intervertebral substance,
between the second and the third vertebrae (the latter carrying
with it the fractured portion of the body of this vertebra), dis-
located forwards. The interspinous ligament between the third
and fourth lumbar vertebrae has also given way, and the inferior
articular process of the former and superior articular process of
the latter are separated by an interval of quite half an inch.

n There was no trace of repair in the spinal fracture discovered on
post-mortem examination, only a little thickened pus between the
interstices of the fractured body of the third lumbar vertebra.”
“ The subject, a petty officer on board a vessel in the harbour,
while engaged in some operation at the top of the mainmast, fell
into the hold, a height of about 60 feet.” He was removed to
the General Hospital, and remained there in a partially para-
plegic state for forty days. “ There was no complete loss of
motion in the lower limbs, but rather a deficiency or impairment
of their movements. Cutaneous sensibility was rather increased.
There was also loss of control over the bladder, but never so great
as to necessitate the use of the catheter. Bedsores formed, and
latterly diarrhoea set in, and the patient died from exhaustion
consequent thereupon.” {Presented by Dr. S. C. Mackenzie,
General Hospital, Calcutta.)

57 Transverse fracture of the body of the first lumbar vertebra. The
upper fragment is displaced forwards, the lower backwards,
thus forming an abrupt posterior curvature. The cord and
membranes were much compressed, highly vascular, and inflamed-
looking. — From a native female, aged 26. She was admitted into

SEEIES I.]

OF THE SPINE.

hospital completely paraplegic, and with a large bedsore over
the sacrum. Stated that fifteen days previously she had fallen
off a wall about six feet high, alighting on the buttocks, and
found she could no longer walk. Three days after, noticed that
there was complete loss of power and of sensation in the lower
limbs, and that a sore was forming over the sacrum. There
was a distinct dorsal curvature of the spine at the injured region.
High irritative fever prevailed during her stay in hospital ; this
was complicated with dysentery latterly, and she died exhausted
on the seventeenth day after admission, and the thirty-second day
of the accident and injury.

58. Fracture of the atlas through the right articular surface, and of

the body of the axis ; dislocation of the atlas from the axis by a
musket-ball, now lying between the right articular surfaces of
these vertebrae and the odontoid process. The annular ligament
is cut across. — From a European who lived nine days after the
receipt of the injury. (Ewart.)

59. Fracture of the rings of the last cervical and first dorsal vertebrae

from a gunshot wound in a European. The cord is shown.
The membranes and substance are considerably damaged.
(Ewart.)

60. The atlas, axis, third, fourth, fifth, and sixth cervical vertebrae,
showing a clean incision or incised wound obliquely across
three-fourths of the body of the sixth, and splitting up the
left articular process and lamina of the same vertebra, to
the root of its spinous process. Another incised wound cuts
through the articulation between the third and fourth vertebrae
on the left side. This incision passes through the whole
thickness of the body of the fourth vertebra, which is thus
divided obliquely from above, downwards and inwards, into
unequal portions. The lamina of the same vertebra on the
right side is fractured vertically.

“ The bones are supposed to be those of one Buddynath Chuckerbutty,
who had been some time missing,” and was believed to have
been murdered. The appearance of the vertebrae leaves no
doubt that the injuries were inflicted by a sword, dhao, or other
sharp-cutting instrument. ( Presented by Dr. W. B. Beatson,
Civil Surgeon, Dacca.)

61. Fracture, more or less complete, of all the ribs except the first and

last, of the left side of the body. The line of fracture extends
obliquely from above downwards and forwards. Firm bony
union has taken place, with comparative little deformity of the
outline of the thorax on the affected side. No history. ( Pre-
sented by Mr. Gr. H. Daly.)

62. A simple fracture of the second rib (right side), about an inch

beyond the angle. The fragments are held together by
periosteum. — From an East Indian woman, aged 50, who fell
off' a couch on to her right side, while suffering from an attack
of fever (to which she ultimately succumbed) ; pain was also
experienced in the right shoulder, and crepitus was felt here
as if due to fracture about the joint. On dissection, however,

FRACTURES AND DISLOCATIONS

[series I.

no fracture was found, but inflammation of the capsular ligament,
and about two drachms of turbid, semi-purulent synovia collected
within it.

63. A preparation showing a comminuted fracture at the lower

third of the manubrium, and a transverse fracture through
the first piece of the sternum just above the level of the
third costal cartilages ; also, multiple fractures of the ribs.
On the left side, an oblique fracture from without inwards
of the second rib, one inch from its eartilagenous attach-
ment. A double vertical fracture of the third rib, one, at
half an inch from the costal cartilage, the other, two inches
beyond this. The fourth rib has two similar vertical fractures
at the same distance from its costal cartilage. The fifth
and sixth ribs have similar double fractures ; the seventh
and eighth ribs single fractures, running obliquely from
without inwards, each half an inch from the cartilage, the ninth
rib has an incomplete (“ green-stick ”) fracture in the same situ-
ation. On the right side, the second and fifth ribs are alone frac-
tured, the direction of the fracture being from within outwards,
and from above downwards, and situated about one-third of
an inch from their respective costal cartilages. — From a
native male, aged 35, who died in hospital eighteen days after
the receipt of these injuries. They were produced by the fall
of a large bale of silk upon his back, from a height of about
fifteen feet. The knees were driven into the chest, and thus
both sternum and ribs were fractured. There was also a com-
pound fracture of the left leg, at its lower third.

64. A badly united oblique fracture of the right clavicle, at its
middle third. The broken ends override each other, and have
united in this position, producing considerable deformity of the
bone.

65. Fracture of the right clavicle at about the centre of the bone.

Firm osseous union has taken place, with a good deal of thicken-
ing in the neighbourhood of the fracture, but no marked
deformity.

66. “ Comminuted fracture of the right scapula, from a native

labourer, who was caught in a surkhi-mill. His right radius
was also broken, the soft parts completely stripped ofl the back
of the right hand, and a laceration of the right axilla, about
six inches" long, exposed the axillary vessels and nerves as cleanly
as if they had been dissected. The patient sank exhausted in a
few hours.” (Colles.)

67. A longitudinal fracture of the right scapula, extending from the

supra-scapular notch, through the spine and body, to within an
inch of the angle of the hone along the axillary margin. This
was the result of a sword- cut. “ The imperfect nature of the
union after seventy-four days is shown.” Much new bone has
been thrown out along the line of fracture, especially on the
ventral surface, but the margins of the divided bone remain
uuunited.

SERIES I.]

OF THE UPPER EXTREMITY.

“The patient was a Chinese, named Wheo Tens; Chong, apparently
about 30 years of age, brought into hospital, having been
attacked bv some unknown individual, and severely wounded by
a sword in the right shoulder, arm, and neck.

“ The strength of the antagonizing muscles was such as to prevent the
divided ends of the spine of the scapula from being accurately
approximated.” The patient, however, did well until attacked
with “ colliquative diarrhoea, under which he sank, having been
seventy -four days under medical treatment. ( PTBsented by

Dr. William Twill, Singapore.)

68. Fracture through the base of the greater tuberosity of the left
humerus, and “ reparation by a considerable formation of new
bone.” During the process of union, the detached tuberosity
seems to have been drawn upwards and inwards by the scapular
muscles (supra-spinatus and infra-spinatus) and thus fixed in its
present abnormal position.

69. Left humerus and some of the soft parts and integument, show-

ing compound, comminuted fracture of the surgical neck,
extending into the joint; oblique fracture of the shaft at the
junction of the upper with the middle third, and transverse
fracture of the olecranon : the ulna up to the point of fracture
has been inadvertently detached. These injuries were inflicted
on the patient (a Hindu woman, aged 35) by a fall from a roof
twenty-five feet high. Amputation at the shoulder-joint was
performed by Dr. Fayrer. (Ewart.)

70. Angular fracture of the shaft of the humerus at the junction of

the middle with the lower third. The convexity is forwards.
There is a good deal of thickening at the site of fracture, parti-
cularly on the lateral and posterior aspects, showing an attempt
at repair. (Ewart.)

71. Preparation showing a compound fracture of the left humerus,

a little below the centre of the shaft. The upper fragment is
seen projecting on the outer aspect of the arm through the soft
parts. There was also a compound fracture of both bones of the
forearm, about an inch above the wrist, and much laceration of
the soft parts. Amputation was performed at the shoulder-joint. —
From a native male, Kylash.

72. The left humerus from a case of compound fracture, in which,

gangrene having supervened, amputation had to be performed at
the shoulder-joint the fifth day after admission into hospital. —
From a native male, aged 30. The fracture is seen to be
comminuted, and situated at the junction of the middle with
the lower third of the bone.

73. Transverse fracture of the right humerus just above the condyles,

with a vertical fracture separating the latter and communicating
with the elbow-joint. The fracture was compound. ( Presented
by Professor Allan Webb.)

74. Compound fracture of the lower third of the shaft of the left

humerus, with great displacement of the fragments. The lower
is drawn upwards and a little outwards in front of the upper
fragment, and terminates in a sharp-pointed, broken extremity,

22 FRACTURES AND DISLOCATIONS] [seeies i.

which protruded through the soft parts (now partially cut away
in order to display the fracture).

75. Compound fracture of the left humerus at its lower third, the

result of a fall from a palm-tree. The subject was a native adult,
a “ toddy-drawer.”

Gangrene of the whole arm succeeded the injury, and amputation at
the shoulder-joint had therefore to be performed.

76. Left arm and forearm of a Hindu lad, aged 20, admitted with com-

pound fracture of the humerus just above, and of the ulna just
below, the elbow-joint. The injury was produced (a month
before) by a fall from the terrace of a house. Amputation at the
shoulder was performed, as the whole of the skin of the forearm
was undermined by abscesses, the radius exposed, and stripped
of periosteum for the greater part of its length, and the fractured
ends of the humerus and ulna were protruding through wounds
at the elbow-joint, as seen in the preparation. (Colies.)

77. The arm and forearm of a native boy, Behari Lai, aged 9, admitted

with compound fracture of the lower end of the left humerus,
just above the condyles, and also Colles’ fracture of the radius.
Amputation was performed at the lower third of the arm, but
osteo-myelitis supervening, the arm had to be removed at the
shoulder-joint. The patient died from pyaemia. On post-
mortem examination, the base of the left lung was found gan-
grenous, and there were multiple abscesses in both lungs, &c.
(Colles.)

78. A comminuted fracture of the lower end of the right humerus.

The fracture was compound, and associated with a compound
fracture of both bones of the forearm, just above the wrist. The
exact injuries to the humerus are as follow : — (1) a transverse
fracture through the lower extremity, immediately above the
epiphysis, completely separating it from the shaft ; (2) an oblique
fracture from above downwards and inwards to meet this, starting
an inch and a half above the inner condyle, and passing also
completely through the shaft ; (3) a transverse, comminuted
fracture of the anterior and upper margin of the trochlear surface ;
and (4) a chipping-off of the pointed extremity of the internal
condyle. — From a native boy, aged 14, who fell off the bough of
a tree, about six feet high, and alighted first on his hand and
then on to the elbow.

79. Transverse fracture, through the the lower epiphysis of the left

humerus, involving the elbow-joint. The radius and ulna not
injured. The fracture was compound, and from improper treat-
ment the limb became gangrenous, so that on admission into
hospital amputation at the shoulder-joint had to be performed.

The subject was a native boy, aged 12. He made a good recovery.
(Presented by Surgeon E. Lawrie, h.b.)

80. Preparation from a case of maltreated compound fracture of the
lower end of the left humerus, resulting in gangrene of the
limb, and necessitating amputation at the upper third of
the arm.

OF THE UPPER EXTREMITY.

SERIES I. ]

The patient, a Mahometan, by occupation a ryot or cultivator, fell off a
mango-tree, about twenty feet high, on to his left elbow. He was

treated by a “ kuberaj,” who did not put up the limb in splints,
but applied some “ ointment. ” The whole arm inflamed,
became very painful, and a foetid discharge began to issue from a
wound at the back of the elbow. When admitted into hospital,
about two months after the accident, the limb was quite
gangrenous, emphysematous crackling extending as high up as

the shoulder-joint. .

An examination of the bones, after maceration and drying, shows a
comminuted fracture of the humerus, about two inches above the
elbow-joint, and involving the latter. The bone seems to have
fractured transversely, and at the same time a longitudinal slit
through the articular surface has taken place, a T-shaped
fracture, resulting in the complete separation of the condyles
from each other, and a division of the trochlear surface into

nearly equal parts.

Around the seat of fracture much new bone has been thrown out, and
forms irregular-shaped, tuberous, and stalactitic masses. At the
lower third of the shaft of the humerus a similar rampart of
new bone is seen, forming a line of demarcation between the
portion of bone above, which is healthy, and the portion below,
which is necrosed and dead. The latter is a piece about two
inches in length, situated immediately above the seat of fracture.
It was almost completely separated from the healthy upper two-
thirds of the humerus.

81. A portion of the lower end of the left humerus, about three and a
half inches in length, just above the inferior epiphysis. This
portion of the shaft constituted the upper fragment of a compound
fracture passing through the epiphysis, and the result of a fall
from a tree upon the elbow. The bone now preserved projected
through the wound, and was destitute of periosteum. It was
therefore sawn off. “ Complete reproduction of the lost bone
took place.” — From a native boy, aged 12. ( Presented by
Dr. W. B- Beatson, Dacca.)

82- Comminuted fracture of the left humerus from a gunshot wound,
with feeble attempt of nature to repair the mischief. — From the
arm of a Burmese, who received the injury in a dacoity. The
limb was removed by amputation near the shoulder-joint on the
thirtieth day after the injury, and the man made a good recovery.
The specimen is interesting as showing the amount of injury a
single ball may produce. (Ewart.) ( Presented by Dr. Fayrer,
Assistant Surgeon, Field Hospital, Army of Ava.)

83. Compound fracture of the left ulna and radius at about the centre
of their shafts. The broken ends of the ulna are protruding
through the soft parts on the inner aspect of the forearm, and
the lower fragment is drawn upwards in front of the upper.
The lower half of the forearm has become gangrenous, and the line
of demarcation at the level of the fractured bones is well-defined.
Amputation has been performed just above the elbow. No
history. ( Presented by Dr. Bowser of Bankoora.)

24 FRACTURES AND DISLOCATIONS [series i.

84. Compound fracture of the right radius and ulna, about two inches
above the wrist-joint, with much laceration of the soft parts.
No history.

85. Compound fracture of the left ulna and radius just above the

wrist-joint. The soft parts in the palm of the hand are much
lacerated, and to a less extent those also on the dorsum of the
hand and ulnar side of the forearm ; while the carpal articula-
tions are exposed, and the little finger has apparently been torn
off. There is no history, but the appearances strongly suggest
a machinery accident. ( Presented by Dr. Esdaile.)

86. A compound fracture of the right ulna and radius, exposing the
wrist-joint. The hand is apparently gangrenous. No history.

87- Compound fracture of both bones of the left forearm, immediately
above the wrist-joint, with protrusion of the upper fractured
ends of the bones through the soft parts on the anterior aspect
of the seat of injury. No history.

88. Transverse fracture of the shaft of the radius, about two and a half

inches above the wrist-joint. The fragments completely over-
ride each other, the lower being drawn behind the upper, and
fixed in this position by periosteal thickening and condensa-
tion. No bony union has taken place “ on account of the age
and debility of the patient, who died three weeks after, from the
effects of injury to the head received at the same time as the
fracture.” (Ewart.) ( Presented by Mr. E. T. Koch.)

89. Compound comminuted fracture of the lower third of the right

radius, involving the wrist-joint. There was also a compound
dislocation of the elbow-joint, and a portion of the anterior
margin of the head of the radius appears to have been chipped
off. Amputation at the lower third of the arm had to he per-
formed.— From a native male, aged 40.

90. Multiple fractures of the carpus and metacarpus.

The patient, a native workman, got his hand caught between the two
cogged wheels of an oil-machine. There was very extensive
laceration of the soft parts. Amputation at the lower third of
the forearm had to be performed.

In the preparation (a dry one) the bones of the forearm ("left) are seen
to be uninjured. In the carpus the unciform and trapezium
have alone suffered. The former is somewhat obliquely fractured
into two nearly equal portions ; the latter has had small portions
of its anterior and outer surfaces chipped off. The base of the
third metacarpal is fissured longitudinally on its posterior aspect.
The second and third metacarpal bones completely fractured ; the
former, transversely at its centre, the latter somewhat obliquely
at the junction of its lower and middle thirds. There is
a comminuted fracture of the proximal phalanx of the index
finger, and of the second phalanx of the middle finger.

91. Compound fracture of the metacarpal bones of the index and

middle fingers of the left hand, with great laceration of the
soft parts. The thumb appears to have been torn away in its
entirety. No history. Amputation has been performed at the
middle of the forearm.

OF THE UPPER EXTREMITY.

SERIES I.]

92. A comminuted fracture of the head of the first phalanx of the

forefinger.

93. The head of the metacarpal bone and the three phalanges of the

right middle finger longitudinally bisected. The middle phalanx
shows the remains of a transverse fracture at about its centre,
with considerable thickening of the bone in this situation, and
deposit of callus both between and around the fiactuied nag-
ments.

The patient, a European sailor, resumed his avocation when the fracture,
treated in the usual way, was believed to he united, but about a
month after, he accidentally received a blow from a rope at the
seat of injury. This was succeeded by some swelling and
great pain. No re-fracture of the phalanx could be detected,
but the pain continued so severe in spite of all treatment
that he consented to have the finger amputated, and this at
once gave relief. On dissection, the digital branches of the
median nerve on either side of the finger were found somewhat
flattened, compressed, and fixed opposite the seat of fracture, and
it is probable that much of the severe pain experienced was
attributable to this condition of the nerves.

94. Dislocation, backwards and outwards, of the left elbow-joint. The

head of the radius is fractured, and also the coronoid process
of the ulna. The latter, drawn upwards by the brachialis anticus,
lies in front of the humerus. The anterior, external, internal,
and orbicular ligaments have all been more or less ruptured.

95. A preparation showing dislocation, forwards and inwards, of the

head of the left radius. The orbicular ligament is partly torn,
the head of the radius resting upon the anterior aspect of the
coronoid process of the ulna.

96. Two preparations illustrating dislocation of the head of the radius

backwards. In one (left elbow) the displacement is slight. The
head of the radius is thrown backwards and outwards. It is of
peculiar formation, being broad and surmounted by a small tubercle
near its posterior margin. The external, lateral, and orbicular
ligaments are torn through. In the other (right elbow) the
displacement is greater, although in the same direction. The
external condyle of the humerus is twisted forwards so as to
rest on the tip of the coronoid process of the ulna. The anterior,
external, orbicular, and a portion of the posterior ligaments are
torn through. No history.

97. Gunshot wound of the right elbow-joint. The head, and an inch

and a half of the shaft of the radius, and a portion of the external
condyle of the humerus, have been blown away. (Ewart.)

98. Gunshot injury of the palm of the left hand, exhibiting great

comminution of the bones of the carpus, compound fracture and
dislocation of the wrist-joint, and extensive laceration of the
soft parts. The injury was probably due to an explosion very
close to the palm of the hand, as the torn tissues are thickly
with the bluish-black granules of gunpowder. No

impregna

history.

FRACTURES AND DISLOCATIONS

f SERIES I.

99. Fracture of the body and descending ramus of the left os pubis,

with a linear transverse fracture of the right symphysis pubis.
No history..

100. Fracture of the right pubes and ischium in a native. The
bladder was ruptured. (Allan Webb.)

101. Fracture of the pelvis, with rupture of the urethra, and extravasa-
tion of urine.

The patient was almost pulseless when admitted into hospital, and
remained so until death, about twenty-four hours after. Peri-
neal section was performed.

On post-mortem examination, “ urine was found effused among the
abdominal muscles in the hypogastrium, and between them and
the peritoneum. The bladder was contracted. Its surface
covered with patches of very dark congestion.” * * * “A

large cavity full of clots and effused urine lay on the right
side of the neck of the bladder, and between it and the
ischium, bounded below by the triangular ligament. The
urethra was torn clean across its prostatic portion, communi-
cating by its torn opening with the aforesaid cavity. The
perineal incision made during life lay in the middle line of the
bulb. The tube introduced by it had been passed, not into the
detached (prostatic) portion of the urethra, but into the space
in question, which extended round in front between the prostate
and symphysis.” * * * “ There was a fracture on each side

through the os pubes in front of the acetabulum, and of the
ischium in front of the tuberosity.”

“ The preparation consists of a portion of the os innominatum on each
side, including the fracture, and of the bladder, rectum, penis,
urethra, and triangular ligament.” (Colles.)

102 The right ilium, ischium, and sacrum, traversed by numerous
fractures. No history. {Presented by Professor Allan Webb.)

103. A preparation showing a comminuted fracture of the right
acetabulum, with forcible thrusting upwards and inwards of the
head of the femur, which has thus become impacted, and now
occupies a portion of the true pelvic cavity.

104. Multiple fracture of the pelvis. The patient, an adult Mahom-
edan, fell from a considerable height upon a rough block of
wood, and was admitted into hospital with a large lacerated
wound in the perineum. There appeared to be, however, no
rupture of the urethra or bladder. The fractures are as follow :

(1) tw’O longitudinal fractures passing from above downwards
and outwards through the body of the sacrum, that on the right
side being comminuted, that on the left incomplete (fissured) ;

(2) a vertical fracture through the body of the pubes on either
side, just internal to the pectineal eminence ; (3) a fracture,
slightly oblique, from above downwards and inwards, through
both ascending rami of the ischia ; and (4) on the right side,
a fracture similarly directed through the descending ramus of
the pubes*. In the fresh state, the ligaments at the symphysis
pubis were found torn through, and the articular surfaces sepa-
rated. No injury to the bladder, rectum, or urethra.

OF THE LOWER EXTREMITY.

SERIES I.]

105 Gunshot fracture of the pelvis, &c. (Case of Lieutenant
R. P. W. II., Her Majesty’s 107th Regiment.)

“ The left os inuominatum and head and neck of the femur
are preserved. The latter, broken into four pieces, the termer
showing extensive fractures about the acetabulum, and body
and descending ramus of the ischium. The bone is greatly
comminuted, and several fragments have been lost.

“ The wound was inflicted by a ‘ Snider ’ rifle-ball, fired from
a distance of twenty-five to fifty yards. The patient, who was
crawling on all fours, having been mistaken for a wild animal.
Amputation was performed at the hip-joint, but the patient died
from shock about three hours after the operation.” (Colles.)
Presented by Dr. Fayrer. ( See also Indicin ]\Pediccil Gcizettet
November 1867.)

106. I ntra-capsular fracture of the neck of the left femur, with the
subsequent formation of a false joint between the trochanter
major and broken neck of the bone.

107. I ntra-capsular fracture of the head and neck of the right
femur.

108. Another well-marked example of intra-capsular fracture of the
neck of the femur (left).

109. Intra-capsular fracture of the head and neck of the lefc femur,
with much comminution of the great trochanter. No history.

110. Long-standing intra-capsular fracture of the femur ( left). No
attempt at union has taken place. The neck of the bone has been
almost completely absorbed, as also a considerable portion of the
brim of the acetabular cavity. The trochanters are rounded off
from the same cause. All the osseous tissues composing and
surrounding the joint are light, porous, and atrophied. ( Presented
by Professor Edward Goodeve.)

111. Intra-capsular fracture of the left femur. From a European
female, aged 40. The joint has been opened from behind.
A transverse fracture is seen dividing the neck of the bone. The
ligamentum teres retains its integrity. No attempt at union has
been made, although the patient was in hospital under treatment
for seven months.

112. A dry preparation, showing (1) an intra-capsular fracture of the
neck of the left femur; (2) an extra-capsular fracture passing
from above, downwards and inwards through the great trochan-
ter— probably comminuted. The latter has united, and an
enormous quantity of new bone has been thrown out around the
fracture and neck of the bone, but the intra-capsular fracture
remains ununited, nor is there any evidence of reparative action
in connection with it. The whole bone is light, spongy, and
exhibits the usual characteristic alterations in structure common

to old age. Taken from a European woman, Mrs. W. , aged

50. She died five months after the accident from “ chronic
diarrhoea.”

113. Ununited intra-capsular fracture of the neck of the right femur. —
From a European woman, aged 50.

FRACTURES AND DISLOCATIONS

[series I.

The specimen shows that almost the whole of the neck and a portion
of the head of the hone have been absorbed, and that little or no
attempt at union, either ligamentous or osseous, has taken place,
although, at the time of the death of the patient, two months had
elapsed since the injury was received.

114:. Impacted extra-capsular fracture of the neck of the left femur.
The impaction of the upper fragment into the cancellous tissue
of the trochanter major is very distinctly seen in the section
which has been made through the bone. The great trochanter
is also seen to have been obliquely fissured on its outer and
posterior surfaces, the fissure terminating 'a little below the
lesser trochanter. This has been completely closed by callus, and
partial bony union has also taken place between the impacted
neck and trochanter major.

The patient, Thomas "VV., a stout, muscular seaman, aged 53, fell “ from
the top of the spare spars, on board the ship, on to the deck, a
height of about ten feet, and alighted on the great trochanter of
the left side.” He was unable to rise, and was carried to the
General Hospital, where the following symptoms were noted : —

‘ “ Decumbency on the back ; left leg everted, powerless ; a good deal
of ecchymosis about the trochanter major. No perceptible short-
ening ; no crepitus ; great pain produced by any muscular
exertion, but flexion and extension can be performed passively to
a considerable extent without inconvenience.’ ”

“No treatment was adopted, except perfect rest in bed and support with
pillows. He soon began to move the limb with his hands and
the other leg, and in twenty-two days was able to go about with
crutches. At this time there was apparent shortening, as the
toes only reached the ground. This was attributed to interstitial
absorption, the more readily, as the trochanter was now found
somewhat flattened. The foot continued everted. He could
never bear much weight upon it, the attempt to do so producing
pain in the situation of the hip-joint.” The patient died of
heat-apoplexy just two months after the accident. {Presented
by Dr. J. B. Scriven.)

115. Extra-capsular fracture of the neck of the right femur, with a
comminuted fracture of the great trochanter. No history.

116. Impacted extra-capsular fracture of the neck of the right femur,
from a native male, aged about GO, who died “ from diarrhoea
and exhaustion nine weeks after admission into hospital.” The
section made shows the impacted condition of the neck — driven
into the cancellous tissue of the trochanter major, — and the
attempt made at union, by means of short bands of fibrous
tissue between the impacted fragments. This tissue, under the
microscope, exhibits incipient calcification.

117. “ Comminuted fracture of the left femur involving the neck
and great trochanter. From an old woman, upon whom a wall
fell ” (Colles). The main fracture passes from above, obliquely
downwards and inwards through the upper part of the great
trochanter, and along the anterior inter-trochanteric line to the

SEBIE9 I.]

OF THE LOWER EXTREMITY.

back of the bone, so as to completely separate the neck from the
rest of the shaft.

118. A comminuted and impacted extra-capsular fracture of the
neck of the left femur, with a considerable amount of callus
thrown out around the fragments. The great trochanter has
also been split through obliquely from above and in front, down-
wards and backwards. (Received from the Police dead-house.)
No history.

119. Extra-capsular fracture of the neck of the right femur, combined
with a vertical fracture of the great trochanter, passing through
its centre, from above downwards, so as to separate it into two
portions, the posterior and outer of which is detached from the
rest of the bone. The neck and shaft of the femur seem to be
much rarefied and softened. — From an East Indian woman, aged
60.

120. The upper portion of the left femur, showing an oblique fracture
of the neck — partly extra-capsular, partly intra-eapsular. Both
trochanters have suffered much comminution, and a large gap
is seen on the posterior surface of the great trochanter from
the complete separation and loss of the fragments at this part.

The patient, a European sailor, died in hospital from shock and other
internal injuries. “ The fracture was caused by a fall from a
height of about ten feet.”

121. “ Oblique fracture of the left femur just below the trochanter
major.” The lower fragment is sharply pointed and displaced
in front of the upper. No union has taken place. The broken
bone is merely held together by a portion of the adductor
magnus muscle.

122. Comminuted fracture of the upper third of the shaft of the
right femur, with partial union of the anterior and internal
portions of two fragments by means of thick fibrous bands
(periosteum). A great deal of new bone has been thrown out
around the shaft both above and below the seat of fracture,
yet no osseous union of the latter has taken place. ( Presented
by Professor Harrison.)

123. Oblique fracture of the left femur below the trochanters. A
section shows that perfect bony union has been established.
(Ewart.)

124. Oblique fracture, from above downwards, and from without
inwards, of the upper third of the right femur, rather more
than one inch below the great trochanter. On the posterior
aspect of the shaft the fracture extends downwards in a linear
form to the middle third, and the upper fragment is wedged
into a Y-shaped fissure formed by the broken bone. —From a
native boy, an idiot, and subject to epileptic fits. The injury
was the result of a fall during a fit, and at the same time a
compound dislocation of the right elbow occurred, with much
laceration of the soft parts, necessitating amjjutation at the
middle of the arm.

FRACTURES AND DISLOCATIONS

[SKBIES I.

125. Oblique fracture, from above and within, downwards and out-
wards, through the whole thickness of the shaft of the right
femur, at about its centre.

A section shows that very perfect bony union lias taken place, although
there is a slight bending outwards of the shaft at the seat of
fracture, which must have produced a certain amount of deformity.
No history.

126. Fracture of the left femur at the middle of its shaft. The broken
ends overlap each other for about four inches, and their
opposed surfaces are held together by shreds of muscular fibre
only.

127. Comminuted fracture of the right femur, at the upper part of the
middle third of its shaft. The fracture was also compound.
The comminuted pieces were removed during life.

On post-mortem examination the soft structures of the thigh were
found almost pulpified. The patient, a European (male), died from
“ exhaustion ” two days after admission into hospital.

128. The lower two-thirds of the left femur, with the upper thirds of
the tibia and fibula. There is an old oblique fracture, from
without forwards and inwards, of the shaft of the former (femur),
at about its centre. The fractured ends of the bone override
each other, but are firmly united by permanent callus in their
unreduced position, thereby producing great deformity of the
shaft of the bone.

There seems also to have been a fracture, or partial separation at any
rate, of the outer condyle of the femur, which has likewise united
firmly. Much new bone has been thrown out over the lower
extremity of the femur and head of the tibia. The knee-joint
was disorganised, and the bones of the leg displaced outwards.
The left lower limb was an inch and a half shorter than the
right. The specimen was obtained on post-mortem examination
of the body of a native male patient, aged 40, who died in hospital
from internal strangulation of the bowels. (“ Medical Post-
mortem Records,” vol. II, 1878, pp. 947-48.)

129. “ Fracture of tlie shaft of the left femur at the lower part of the
middle third.” The fracture is oblique, and its direction from
above downwards and forwards. “ Section shows that the
bones have overridden each other about three inches. The upper
fractured extremity, which is in front, has become rounded off,
and the dense cortical layer formed over it is continued down-
wards and merged in that of the lower fragment. The same
is noticed at the end of the lower fractured extremity, but it is
comparatively irregular and rugged, both the periosteal and
cortical layers of the adjacent bones have been substituted by
cancellated structure. The increased compactness of a part of
this indicates the position where this transformation has been
accomplished.”

130. “ Oblique fracture of the shaft of the left femur at its lower
third. There is considerable overriding of the broken ends, each
of which terminates in a conical bony point. Notwithstanding the
great malposition that must have existed, the cortical and peri-

8EKIES I.]

OF THE LOWEK EXTREMITY.

131.

132.

133.

134.

135.

osteal structures of the opposed bones have been to a considerable
extent joined by the development of new bone (forming solid
bridges between them). The overriding is lateral, the upper
fractured end lying outside the lower on the inner aspect.”
(Ewart.) The exposed medullary canal of each fragment has in
great part been tilled up by new bone.

Comminuted fracture of the lower third of the left femur,
with necrosis of the shaft for from one to two inches above the
seat of fracture. Considerable new bone has been thrown out
around the broken fragments, but no union of the fracture has
taken place.

“Fracture of the lower part of the femur, transversely and
between the condyles, into the left knee-joint. The" outer
condyle has been pulled upwards more than half an inch, but
sufficient osseous union has taken place to fix the parts firmly
together. The upper broken end overrides the lower to the
extent of three inches, and a sharp splinter or spicule projects
considerably. _ The opposed bones have been united by a bridge of
new bone, which is irregular and much perforated. " The injury
inflicted upon the knee-joint seems to have been repaired, for the
condyles and articular surface of the tibia are healthy. Kemoved
from the body of Charles Wilson.” (Ewart.)

“ Comminuted fracture of the lower end or the left femur
extending into the knee-joint.” (Ewart.) The whole of the
injury appears to be included within the joint. A transverse
fracture is seen passing completely through the shaft of the femur
about two and a half inches above the condyles ; a vertical fracture
extends downwards from this, between the two condyles com
pletely separating them. A third is directed downwards and
forwards on the outer aspect of the external condyle • and a
fourth, connecting the two latter at their inferior terminations
chips off a portion of the articular surface of the same condyle ’
Oblique “ fracture of the left femur at the lower third. Section
shows that, though the fractured extremities have overridden
much and been maintained in an unfavourable position bonv
union has taken place. The lower fractured end has been pushed
up behind the upper broken extremity three or four inches,
.vet then ends have been blocked up and smoothed by the
development and growth of new bone, and the opposed surfaces
of both are joined by new cancellated structure, the opposite
periostea having become absorbed after having contributed to
the formation ot an osseous substitute. The deformity consists
m thickening and irregularity at the seat of injury and repair
and bending or twisting of the femur forwards and outwards.”’

A dry preparation from a case of compound comminuted fracture
of the lower third of the left femur. The patient was a Maho
medan,aged 23, admitted into hospital on the 3rd January

ii TiJUry^aS ?USCd by " carriaSe*wfceel passing ovi
thigh. 1 he soft parts were not much lacerated. The wound

was dressed aM.septic,lly after the prominent ends of uTtZ

FRACTURES AND DISLOCATIONS

[series I.

were removed, and the fracture reduced. The patient did
well for upwards of two months, but then the knee-joint was
found affected, and articular suppuration threatening, amputation
of the limb was necessitated, and performed at the upper third
of the thigh, on the 23rd of March.

The dry preparation exhibits in a Yery beautiful manner (1J the
oblique and comminuted nature of the fracture, with displace-
ment of the fractured ends of the bone (the upper outwards,
the lower inwards and backwards) ; (2) an immense growth of
new bone at the seat of, and for some distance above and below
the same, with partial union and consolidation of the broken
fragments by means of osseous arches thrown out between them ;
and (3) the superficially furrowed and roughened condition of
the condyles of the femur (particularly the inner), the result of
inflammatory changes within the knee-joint.

136. A dry preparation showing an oblique comminuted fracture of
the left femur at its lower third. The fragments are greatly
displaced, but have united to a considerable extent in their
abnormal position by firm bony outgrowths. The fracture
extends obliquely from within, outwards and downwards. The
upper fragment has been displaced downwards, and its sharp
pointed end, perforating the knee-joint, rests on the external
surface of the outer condyle, and has a good deal of rough new
bone thrown out around it here. The lower fragment has been
drawn upwards and backwards. The medullary canal in this
portion has been exposed for a considerable distance, and is seen
partially filled up by newly formed bone. The sharp edges of
the fracture have been rounded off to a great extent, but some
sharp spicules still exist. The knee-joint was extensively dis-
organised, the cartilage over the condyles and head of the
tibia eroded, the ligaments softened and partly destroyed.

The patient, a native female, aged 60, sustained these injuries, about
two months prior to her admission into hospital, by slipping
down a stone staircase. She was in a very low and depressed
condition. Several large burrowing sinuses surrounded the
lower part of the thigh and the knee-joint, and the discharge
from these was so profuse that she died from exhaustion and
diarrhoea before any operative interference could be attempted.

137. An oblique fracture of the left femur, at its lower third, directed
from behind, forwards, downwards, and outwards. The upper
fragment overrides the antero-external aspect of the lower, and
in this situation must have perforated the knee-joint. It is
remarkable how well the parts have adapted themselves to their
abnormal position. Firm bands of fibrous tissue extend between
the displaced fragments ; these have been cut across posteriorly
to display their structure. The ends of the fractured bone are
rounded off to a considerable extent, and invested by thick
periosteal tissue. The subject, a native male, aged 40, died from
gangrene of the left leg and foot, the result of a recent injury
( the fall of some heavy “ iron-sheeting ” upon the leg), and
this old fracture of the femur, on the same side, was dissected

SERIES l]

OF THE LOWER EXTREMITY.

out at the post-mortem examination of the body. ( Presented by
the Police Surgeon, Calcutta.)

138. A dry preparation, from a case of compound comminuted
fracture at the lower third of the right femur. The bone is
greatly splintered at the seat of injury, and a vertical fracture
through the centre of the condyles extends into the knee-joint.

The patient, a native woman, fell olf the roof of a house, a height of
about 22 feet. Besides this fracture of the thigh, she sustained a
Colles’ fracture of the right radius, fracture of the nasal bones,
and a double fracture of the lower jaw. She was brought to
the hospital in a collapsed and semi-insensible condition. The
thigh was amputated, but she sank on the fourth day after
the operation.

139. “ Specimen showing extensive comminuted fracture of the

(’eft) femur below the trochanters, and embracing a con-
siderable portion of its upper third.” (Ewart.) The case is
as follows : — “ Gunner William Radcliffe, aged 27, was wounded
at the battle of Goozerat on the 21st February 1849 by
a round shot striking the upper and anterior part ot the left
thigh, by which the bone was splintered a little below the
neck, and the soft parts much injured. He was brought
into Lahore on the 3rd April, and on the 6th, forty-four days
after the receipt of the injury, amputation at the hip-joint
was performed. The wound, at first affected with gangrene,
eventually did well ; but in the process of healing his constitution,
previously weakened by profuse suppuration, gave way, and he
sank under the prolonged debilitating effects of so severe an
injury. He died on the 20th of the same month, fourteen days
after the operation, sufficiently long to prove the success of the
operation itself, and to render it apparent that, had the limb
been removed some time before, the chances are he might have
recovered.” (Presented by Surgeon P. F. H. Baddeley, Artillery
Division, Lahore.) *

140 “ Comminuted fracture of the upper third of the left femur,

with imperfect formation of new bone adhering to the upper and
lower fractured extremities, as well as to the comminuted
portions affected through their periosteal aspects.

“ The subject of these was a Burmese, who was shot through the thigh,
at the capture of Rangoon, on the 13th or 14th of April. He
was brought to the field hospital some days afterwards. He
died on the 4th August 1852 from debility and exhaustion,
produced by the discharge from the wound, and an attack of
diarrhoea. The thigh was full of sinuses, extending in all
directions, and the cavity of the callus also contained a quantity
of pus. There was no opportunity of performing amputation.
The man’s condition when brought to hospital precluded it,
and subsequently it was not deemed advisable.” (Ewart.)
(Presented by Dr. Fayrer, Field Hospital, Rangoon.)

141. Comminuted fracture of the upper third of the left femur,
the result of a musket-shot. (Ewart.) “ Moung Shine-Ko, a
Burmese, aged about 30, received a musket-shot in the upper

34 FRACTURES AND DISLOCATIONS [series i.

part of the left tliigli on the 15th of February 1853, causing
fracture of the femur into the hip-joint. Amputation at the hip-
joint was immediately performed * * * * After recover-

ing from the shock, which appeared to have been very great, the
patient continued well until the 5th March, when symptoms of
tetanus supervened, and carried him off on the 17th.” (Abstract
from case.) (Presented by Dr. Fayrer, Officiating Civil Surgeon,
Rangoon.)

142. A large fragment of the femur, with a portion of attached
muscle, removed from the right thigh of a lascar, who was shot
through both thighs by a tiger-trap on Saugor Island. (Colies.)

143. “T ransverse fracture of the middle third of the (left) tibia and
fibula.” (Ewart.) The whole length of the shafts of both bones is
greatly thickened and roughened from inflammatory changes —
ostitis and periostitis, — the tibia in particular exhibiting great
density of its compact tissue (sclerosis).

144. Oblique fracture of both bones of the left leg at the junction of
the middle and lower thirds of their shafts. The fractures are
directed from without, downwards and inwards, and the upper
fragments override the lower for from one to two inches, yet
complete bony union of the opposed surfaces has taken place,
and the tibia and fibula are also joined together at the scat of
injury by a thick, firm bridge of osseous tissue.

145. “ Fracture of the right tibia and fibula, near and into the ankle-
joint.” (Ewart.)

The injury seems to have been an oblique fracture, from above, down-
wards and inwards through both bones, about two and a half
inches above the ankle-joint; the inferior extremity of the tibia
being further broken into at least three pieces, and the ankle-joint
itself thus implicated. Firm bony union has taken place, chiefly
by means of strong bridges of new bone thrown out between the
fragments, and the two bones are thus also joined together. The
lower end of the fractured fibula overrides the upper for about
half an inch.

146. Compound comminuted fracture of the right tibia and fibula,
exposing the ankle-joint. No history.

147- A dry preparation from a case of “ compound comminuted
fracture ” at the middle third of the left tibia and fibula. Both
bones have undergone very extensive splintering at the seat of
fracture. The fragments have been put together artificially.

148. Compound fracture of the right tibia and fibula, implicating
the ankle-joint, and producing dislocation of the foot outwards.
No history.

149- Compound fracture of the right tibia and fibula, at about the
centre of their shafts. The injury is said to have been “ of six
months’ standing, ” and “ from a native patient aged 35 years.”

The bones have necrosed at the seat of fracture, and show no attempt
at repair.

150. Transverse fracture of the left tibia and fibula, at a little below
the centre of the shafts. — From a native woman, aged 25. Both
bones of the right leg were also fractured, and on each side the

SEHIES I.]

OF THE LOWER EXTREMITY.

fracture was compound. At the seat of injury (and in the tibia,
at a spot about three inches above the same), the bones aie
superficially necrosed and roughened. Abscesses connected with
the diseased bone burrowed among the soft parts on the antenor
and outer aspects of the leg. The knee-joint became affected,
and at last amputation at the lower third of the thigh had to he

performed. ^ ,

151. Compound fracture of the left tibia and fibula, with dislocation
outwards of the foot, also compound. In the tibia the fracture
passes through the base of the internal malleolus, as well as
involving a triangular piece at the lower extremity of the same.
The fibula is broken about an inch above the joint. The ankle-
joint is freely exposed. “The surrounding soft parts were
found much lacerated and contused, but the tibial arteries were
uninjured.” Amputation at the middle third of the leg was
necessitated.

From a native named Baksha, who was run over by a carriage in the
streets, the wheels passing over his leg and foot.

152. Oblique fracture, from above downwards, and from without
inwards, of the right tibia and fibula. In the former at its lower,
and in the latter at its middle third. The fracture was a com-
pound one, and the leg had to be amputated below the knee-
joint. — From a native named Indro.

153. “ Comminuted fracture of the right tibia, extending into the
knee-joint. The head of the fibula is also fractured. Ampu-
tation was performed above the joint.” (Colles.) ( Presented by
Dr. Herbert Baillie, Chandni Hospital.)

154. A very beautiful preparation, showing an old fracture of the right
tibia and fibula, at about the centre of the shafts, with displace-
ment inwards and forwards of the upper fragments, which have
united in this position, and are connected together at the site of
fracture by strong bridges of newly formed bone. The lower
end of the upper fragment of the tibia projects forwards consider-
ably, but is smooth and conical (rounded off). The lower frag-
ments are embossed with rough, rugged, almost coral-like, newly
formed bone, the result probably of the excessive reaction of the
periosteum investing them. There is ankylosis of the ankle-joint.

No history of this case has been preserved, but in all probability the
fractured bones were never “set” (reduced), — simply allowed
to unite as best they could. The preparation is therefore most
interesting in showing the very great amount of natural repair
possible, even in such an extensive injury.

155. Compound comminuted fracture of the lower third of the right
tibia and fibula. The ankle-joint was exposed, and several of
the tarsal bones crushed. The injury was produced by the fall
upon the leg and foot of a heavy block of wood. Amputation
had to be performed at the junction of the middle and upper
thirds of the leg. Both bones are seen to be extensively splin-
tered, chiefly in a longitudinal direction, and the tips or extremi-
ties of the internal and external malleoli are broken off. The
Iractures communicate freely with the ankle-joint.

FEACTUEES AND DISLOCATIONS

[series I.

156. Compound comminuted fracture of the lower end of the left tibia,
with fracture of the malleolar extremity of the fibula, and dis-
location, forwards and outwards, of both bones of the leg. The
ankle-joint is freely exposed.

The patient, a native woman aged 30, had fallen from a height of
about ten feet, and thus sustained the injury. The leg was
amputated at the junction of the lower and middle thirds.

157. Transverse fractures of the right tibia and fibula at their lower
thirds, the former of which was compound, the latter simple.

The patient, a Hindu aged 25, was brought into the hospital about
six hours after the receipt of tne injury, which was produced
by the fall of a bale of cloth upon his leg. He was very weak
and emaciated, bad an enlarged spleen, and had been suffering
for some time from malarious fever. The fractures were reduced
and the wound dressed antiseptically. The patient did well
until the fourth day of his admission, when secondary haemorrhage
occurred, and he became very low. The blood extravasated into
the neighbouring tissues gave rise to gangrene, and consequently
amputation had to be performed at the knee-joint. The flaps,
however, sloughed, and the man died exhausted on the fifteenth
day after the operation.

158. Preparation showing a comminuted fracture of the lower third
of the left tibia and fibula, which was also compound.

The fracture in the latter bone is for the most part transverse in
direction, but has also completely detached a small portion of
the inner compact tissue of the shaft. That through the tibia
passes from without, inwards and downwards, producing not
only detachment of several fragments, but extensive Assuring
of the shaft.

The injury was brought about by the shifting of a heavy fresh-
water pump in consequence of a sudden lurch of the vessel,
while the patient (a Mahomedan carpenter, aged 31) was engaged
in closing a port-hole on board one of the pilot-brigs oft1 the
Sandheads. No attempt Avas made to reduce the fracture, r'but
the leg was tightly bandaged, and the man was sent into
hospital five days after the accident. Gangrene had then
set in, and extended from the foot to the knee. Amputation at
the lower third of the thigh was at once performed, but the man
died from exhaustion and shock within twenty-four hours of
the operation.

159. The right tibia and fibula from a case of compound fracture of the
leg, occurring in a native male (an idiot), who fell from a height
of about twelve feet.

In the tibia the fracture is an oblique one, running from above down-
wards and outwards through the entire thickness of the shaft,
commencing at the middle, and terminating at the' lower
third of the bone. In the fibula, the fracture is situated at the
upper third, is also oblique, takes the same direction, and, from
its upper end, a narrow fissure is prolonged for half an inch into
the outer aspect of the shaft.

SERIES I.]

OF THE LOWER EXTREMITY.

160. The bones of the right leg, from a case of compound comminut-
ed fracture.

The subject was a native boy, aged 10 years, who was run over by a
railway-train. Amputation was performed at the lower third
of the thigh twenty hours after the accident. The patient
survived the operation only five hours. It will be seen that the
tibia, at its middle third, has been most extensively comminuted.
Three large fragments of the shaft, which had completely
separated, have been artificially replaced, and show that the
splitting up of the bone was chiefly in the longitudinal axis.
The fragments from the anterior aspect of the bone are wanting,
and a large gap exists here.

At the upper third of the fibula the bone is also greatly comminuted,
a transverse fracture passing almost through the bone on its
outer aspect, a bending (not complete fracture) two inches below
this, and five longitudinal fissures converging towards the same
spot. The bones of the foot are uninjured.

161. Compound fracture of the left tibia at the upper end of the
shaft, just below the superior epiphysis, with separation of the
latter, and of the fibular epiphysis. The fibula is also fractured
about an inch below its upper extremity.

The subject was a native boy, aged six years. The injury was caused
by a heavy bale of cotton falling upon his leg. There was
much displacement of the upper fragment of the fractured tibia,
and considerable injury to the knee-joint. The limb had there-
fore to be amputated at the lower third of the thigh.

162. Compound comminuted fracture of the right leg from gun-shot
injury. Amputation was performed through the knee-joint.

The shaft of the tibia, at its upper third, is extensively splintered, no
less than six fragments or spicula being found on dissection, and
which are now placed in position in the preparation. They are
all of irregular outline, with sharp edges and pointed angles.
The fibula has sustained a transverse fracture through the whole
thickness of its shaft, a little below the level of the seat of injury
to the tibia.

The patient, a native male, aged 23, was firing off a small toy-cannon,
ahd accidentally received the charge in his leg.

163. An oblique fracture, from without downwards and inwards, of
the left fibula. It shows “ little or no attempt at repair.”
Possibly this is due to the line of fracture passing through or
very close to the medullary foramen, and thus interfering with
the principal nutrient supply of the bene. The fibula is uninjured
No history.

164. “ Compound comminuted fracture of the right tibia ” at its upper
third. (No history.) The lower fragment is seen projecting
through the soft parts.

165. “ Compound fracture of the (left) tibia,” at about the centre
of the shaft. The upper fragment overrides the lower, and
projects for more than two inches through the soft parts. * The
line of fracture is transverse. No historv.

38 FRACTURES AND DISLOCATIONS [series i.

166. Fracture of the right tihia, at the centre of the shaft, slightly
oblique in direction from above downwards and outwards. From
a native male (Jaffer Alii). The fracture was compound. The
fibula remains uninjured.

167. Comminuted fracture of the right tibia, at about its middle third.
There is much superficial caries and exfoliation of bone around
the site of the fracture, and extending upwards on the outer and
posterior aspects of the shaft. The fracture was compound. —
“ From a native male (Shaik Farrid), aged 22 ; admitted into
hospital on the 31st December 1868. Amputation at the upper
third of the thigh performed, 20th January 1869.”

168. A dry preparation from a case of compound fracture of the right
tibia, at the centre of the shaft. The injury was produced by
a cart-wheel passing over the leg of a native boy, aged 14.
There was much laceration and contusion of the soft parts, and
amputation at the lower third of the thigh had to be performed.
The fracture of the tibia is incomplete, its direction transverse.
The anterior prominent margin or “ shin ” remains unbroken,
holding together the upper and lower fractured portions of the
bone, which, moreover, at the line of separation, show a very
curious dovetailing of their margins into each other. The shaft
has been bent a little inwards. The fibula was found uninjured,
and the epiphysis of the tibia not affected.

169. “ Compound comminuted fracture of the lower third of the
(right) tibia.” (Ewart.) No history.

170. “ Compound comminuted fracture at the lower third of the
(left) tibia.” (Ewart.) No history.

171. A double fracture of the left tibia. One is situated at the
junction of the upper and middle thirds, the other, at the lower
third of the shaft of the bone. Doth fractures are oblique, and
directed from without, downwards and inwards. “ The soft
parts were much lacerated,” but the fibula remains entire
throughout its extent. — “ From an adult native male patient.”

172. A dry preparation from a case of compound comminuted fracture
of the tibia at its lower third. This bone has been broken
into no less than eight irregular-shaped large and small frag-
ments, and the ankle-joint implicated thereby. (The fibula is
said to have been also fractured about two inches above the
malleolus.) There is no history preserved of the cause of this
extensive injury, but it is recorded that “ gangrene supervened
ten days after, and amputation had to be performed in conse-
quence at the lower third of the thigh.” (Ewart.)

173. “Fracture of the right fibula (oblique), within three inches
of the malleolus, overriding fully two inches. Union between
the opposed surfaces is complete notwithstanding,” and has been
effected by means of strong bridges of new bone.

174. Oblique “ fracture of the right fibula, within four inches from the
head ; overriding of an inch of the fractured ends; very complete
(bony) union.” (Ewart.)

SEB1ES I.]

OF THE LOWER EXTREMITY.

175. Preparation showing a perfectly united oblique fracture of the
right fibula, directed from above, downwards and inwards, two
and a half inches above the ankle-joint.

There is considerable superficial caries of the astragalus and articulating
surface of the tibia, and a roughened and eroded appearance of
the lower three inches of both bones of the leg, the result also
of inflammatory changes. The ankle-joint was involved.

From a native male, aged 55, who was run over by a carriage in the
streets. An attempt was made to save the limb, but ultimately
amputation at the upper third of the leg had to be performed.

176. Compound fracture of the left fibula, producing an oblique
splitting of the bone from a point on the outer side of the shaft,
two and a half inches above the ankle-joint, downwards and
inwards into this articulation. A portion of the external malle-
olus appears also to have been chipped off.

There is no fracture of the tibia, but the inferior tibio-fibular articu-
lation was involved, and both bones are here roughened and
superficially carious, as also is the whole of the lower fragment
of the fractured fibula. This, the result of prolonged periosti-
tis, with burrowing sinuses in the neighbourhood of the joint,
necessitated amputation of the leg.

177. Pott’s fracture of the left fibula . The fracture, situated about
an inch and a half above the tip of the external malleolus, passes
obliquely, from without inwards and downwards, through the
shaft and into the ankle-joint. Portions of the anterior and
external ligaments of the joint are ruptured. (There is also a
fracture of the first phalanx of the second toe.)

Taken from a Mahomedan woman, aged 35, “ who fell upon a heap of
broken glass.” She died thirteen days after the accident from
traumatic tetanus.

178. Comminuted fracture of the os calcis, and first, second, third,

and fifth metatarsal bones. No history. (Presented bu Profes-
sor Allan Webb.) J

179. Comminuted fracture of the os calcis. “ The principal fracture
extends from below and in front, upwards and backwards
to the posterior edge of the articular surface correspond-
ing to the astragalus. A portion of this surface was detached
and lying loose in the joint. The calcaneo-cuboid ligament had
torn off the piece of the os calcis to which it is attached.” (Colles.)

The case of Mrs. K., aged 42, who fell from the upper story of a
house, landing on her left heel. Traumatic gangrene set in, and
amputation had to be performed above the knee.

180. A dry preparation from a case of compound comminuted and
multiple fracture of the right tarsus and metatarsus. Foot
amputated by Syme’s operation.

The fractures involve the heads of all the metatarsal bones except the
fifth, the first being extensively splintered. The internal cunei-
form, base of the second metatarsal bone, the cuboid, and os calcis
also show fracture or chipping-off of portions of their structure,
and the first phalanx of the third toe transverse Assuring at
about its centre.

40 FRACTURES AND DISLOCATIONS. [sebies i.

181. The left os calcis of a native (male), aged 40, who sustained
a compound comminuted fracture of this bone in a gun-
powder explosion on board a torpedo- vessel in the river. The
injury was caused by a piece of iron forcibly striking the
outer side of the left foot. Several detached fragments of the
bone were found loose in the tvound, which was large and lacer-
ated, involving the ankle-joint and lower third of the leg. Am-
putation at the upper third of the leg was performed.

182. A dry preparation of the left foot of a native, aged 40, crushed
by the passage over it of the wheels of a railway carriage.
The tarsal bones are uninjured, but all the metatarsal bones are
fractured from half an inch to an inch above their heads, the line
of fracture passing transversely through them. The proximal
phalanx of the little toe is also completely fractured a little above
its base. All the other phalanges of the toes have escaped. The
laceration of the soft parts was so extensive that amputation
(Syme’s) had to be performed.

183. “ Complete dislocation of the head of the left femur on to
the back of the ischium.” The capsular and cotyloid liga-
ments are ruptured, and the external rotator muscles partially
torn through.

184. “ Compound dislocation of the right tibia at the knee-joint, with
separation of the upper epiphysis. No fracture of the femur or
fibula. The ligamentum patellae, the patella, and the quadriceps
tendon, are uninjured. The integuments have been torn across a
little above the ankle, one portion has been stripped back off the
foot (having given way along the dorsum of the first metatarsal
bone) and remains attached only to the toes, the other has torn
up the front of the leg, and has been stripped from the leg and
thigh nearly as high as the site of amputation. The case of a
native girl (Nattia), aged 4, run over by a train on the muni-
cipal railway at Sealdah.

The right thigh was amputated above its centre. The patient rallied
after the operation, and survived it for upwards of twenty-four
hours, dying, however, of shock and exhaustion.” (Colles. ) ( Pre-
sented by Professor J. A. P. Codes.)

185. Compound dislocation of the left ankle-joint, with fracture of
both bones of the leg. The astragalus with the rest of the foot
is displaced forwards. The tibia is broken off' nearly trans-
versely, about three-fourths of an inch above the joint, the fibula
about three and a half inches above the same. The upper frag- *
ment of the former protrudes for nearly three inches through the
soft parts on the inner side of the ankle-joint.

186. Complete dislocation (compound) backwards of the left foot.
The tibia, removed from its articulation with the astragalus, is
pushed forwards and a little inwards through the soft parts, and
almost ad the ligaments of the ankle-joint have been torn through.
No history. ( Presented by Dr. Esdaile.)

187. Compound dislocation of the foot outwards, with fracture of the
fibula about two and a half inches above the ankle-joint, and

SERIES I.]

FRACTURES IN LOWER ANIMALS.

protrusion of the lower extremity of the tibia through the soft
parts on the inner and anterior aspects of the joint. No history.

188. “ Compound dislocation of the left ankle, with fracture of both

malleoli (which remain attached to the foot), and protrusion of
the tibia and fibula through the wound on the outside of the
joint. The epiphyses of both bones separated on the third day
after the injury. Amputation was performed through the middle
of the leg.” (Colles.)

189- Multiple fractures of the bones of the lower extremity.

The preparation exhibits “ fractures of the right femur, tibia, and fibula
in a native, sustained in the great cyclone of 5th October 1861.”

The ends of the fibula override slightly, and are united by their sides,
which come into contact. The fragments of the tibia are
everywhere one-fourth of an inch apart, but are united by a large
mass of callus formed on the outer side of the bone, nearly filling
the interosseous space. The gradual “ modelling ” of the fractured
bones is well illustrated ; the separate ends of the tibia are
well rounded off, though the medullary canal is still open (after
eight months) in both bones.

The femur has been broken across, nearly transversely about the middle,
and a second fracture, running downwards from the first
through the lower fragment, separated a piece of bone on its
outer side.- This has reunited to the lower fragment, but no
union between the two main fragments ever took place; on the
contrary, their ends are well rounded, showing that considerable
motion persisted between them. Mr. Partridge inserted two
ivory pegs (which still remain) in the outside of the upper
fragment. This led to the formation of some callus at the
back of the upper, and in front of the lower, fragment; but
before any further improvement could take place the ’ man
died of pyiemia.” (Colles.) ( Presented by Professor S. B.
Partridge, f.r.c.s.)

190. A section from the base of the skull of a horse, showing a
comminuted fracture. The cause of the injury not known.
“ The animal was found dead in his stable.” ( Presented by
R. S. Hart, Esq., m.r.c.v.s., Calcutta.)

191. “ Fractured rib of an ox, partially united.” (Ewart.)

192. “ Transverse fracture of the body of the scapula of a sheep. ”
(Ewart). A large amount of ossifying callus surrounds the
fracture.

193. “ Fracture and imperfect union of the bones of the wing of an
adjutant (Leptoptila ary ala, Linn.), showing to great advantage
the provisional callus which has encased the broken ends of the
bones.” (Ewart.)

194. “ Section of the femur of a hog {sus Indicus), which had been
fractured at its middle. The bones have overridden each other
but complete bony union has been effected.” (Ewart.)

195. “ Fracture of the femur of a pheasant. The bones override
but the opposed surfaces, though separated a quarter of an inch’
are joined by bony material.” (Ewart.)

42 FKACTUKE OF PATELLA. [semis i.

196- A dry preparation of the forefoot of a young “ Waler” (horse),
showing comminuted fracture of the sesamoid bones. ( Presented
by It. S. Hart, Esq., m.k.c.v.s., Calcutta.)

197. Compound comminuted fracture of the left patella. The
injury is best seen from the inferior surface of the bone. The
principal fracture extends from above, downwards and inwards,
through the whole thickness of the inner third of the bone,
which is separated from the rest, and broken into three un-
equal fragments. These are held together by the fibrous
expansion of the ligamentum patellae which passes over the
front of the bone. The outer half of the patella exhibits,
near its lower margin, two distinct fissures in the articular
cartilage investing its under surface, these enclose between
them a triangular portion of the latter which has almost exfo-
liated.

The knee-joint was implicated. An attempt, however, was made to
save the limb ; but, acute suppurative synovitis ensuing, with
burrowing abscesses on the inner side of the leg and thigh,
amputation had to be performed, about two inches above the
joint, on the 19th day after admission. The patient, a Mahom-
edan, aged 25, by occupation a mason, died on the fifteenth
day after the operation from exhaustion and septicaemia.

The fracture was the result of a fall from a three-storied house. He
sustained at the same time a Colles’ fracture of the right
radius and other minor injuries.

KBIES II.]

DISEASES OF THE BONES.

DISEASES OE THE BONES.

INDEX TO THE SERIES.

A.— ANATOMICAL : showing the bone affected.

1. — Skull —

(а) Hypertrophy, 1, 2, 3, 4, 5, 6, 7 (4, 5, 6, and 7 from syphilitic

changes).

(б) Atrophy, 8.

(d) Hydrocephalus, 2.

(e) Microcephalus, 11.

\f) Inflammation, 4, 12, 13, 14.

(g) Caries, 3, 14, 15, 16, 17, 18, 19, 20.

(A) Necrosis, 15, 20, 21, 22, 23, 24, 25.

(t) Tumours ,* 26, 27, 28.

2.— Jaw-bones —

(a) Necrosis, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43.
(0) Tumours,* 44, 45, 46, 47, 48, 49, 50, 51, 62.

3.— Teeth—

(a) Caries, 53, 54.

( b ) Necrosis, 55.

(tf) Hyperostosis, 5 6b.

( e ) Excessive deposit of tartar, 67.

4.— Stebnum and Kibs —

(а) Kiekets, 58.

(б) Syntosis, 59, 60
(r) Necrosis, 61.

(d) Melanosis, 62.

6.— Clavicle—

(a) Caries, 63.

6. — Scapula —

(a) Caries, 64.

For many other preparations of

tumours connected with bone, sec Sene* XVII.

DISEASES OF THE BOISE S.

[SERIES II.

7. — Humerus —

(«) Hypertrophy, 65, 66.

(b) Inflammation, 67, 68-

(<•) Suppuration (osteo-myelitis), 69, 70, 71, 72, 73, 74.

(d) Caries, 75, 76. 77, 78, 79.

(e) INecrosis, 76, 80, 81, 82, 83, 84.

(f) Tumours, 85, 86, 86a.

8— Radius and Ulna —

(a) Rickets. 85, 87.

( b ) Caries, 77, 78, 79, 88, 89.

(cl) Osteo-myelitis, 92.

( /) Tumours, 93.

9. — Bones of the Hand — ^

(a) Inflammation, 94.

(b) Caries, 78, 95, 96, 97, 98, 99.

(e£) Tumours, 93, 101.

10. — Os Innominatum —

(a) Caries, 102.

11. — Femub —

(a) Rickets, 103, 104, 105.

(i) Scrofulous disease, 106.

112, 113, 114, 115, 116, 117.

(d) Suppuration (osteo-myelitis), 118, 119, 120, 121, 122, 123.

(e) Caries, 112, 124, 125, 126, 127, 128, 129, 130.

(/) Necrosis, 114, 127, 131, 132, 133, 134, 135, 136.

(g) Tumours and bony outgrowths, 137, 138, 139, 140.

12. — Tibia and Fibula—

(a) Atrophy, 141.

(b) Rickets, 142, 143, 144.

( r) Scrofulous disease, 106.

(c?) Inflammation (ostitis), 145, 146, 147, 148, 149.

(e) Suppuration (osteo-myelitis), 150.

(/') Abscess, 151.

(q) Caries, 127, 128, 152, 153, 154, 155, 156, 157, 158, 159, 160,
161, 162.

(h) Necrosis, 127, 157, 159, 160, 161, 163, 164, 165, 166, 167, 168,

169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180,
181.

(i) Amputation stumps, 150, 182.

13. — Bones of the Foot—

(a) Fatty degeneration, 183, 184.

(b) Caries and necrosis, 161, 185, 186, 187, 188, 189, 190.

14. — Bones of the Lower Animals —

(a) Hypertrophy, 191.

(b) Necrosis, 192.

SERIES II.]

DISEASES OF THE BONES.

B.— SURGICAL: Illustrating the symptoms and result

OF TREATMENT IN DISEASES OF THE BONE *

1. — Skull—

Inflammation of brain or membranes in diseases of, 13, 14, 20, 22,
23, 24.

Ulceration with perforation, 12(P), 15, 16, 17, 19, 20.

2. — Face—

Operations on jaw-bones for tumour, 49, 50, &1, 52.

Antrum, tumour of, 45.

Palate, perforation from syphillis, 30

3. — Long bones —

Disease limited to shafts of, 65, 66, 67, 84, 108, 109, 110, 111,
113, 115, 116, 117, 121, 129, 130, 131, 145, 149, 152, 155, 156,
162, 163, 164, 165, 166, 167, 169.

Disease limited to epiphysis of, 68, 80, 106.

Epiphysis or articular end involved in disease of shaft, 71, 72, 73,
74, 77, 83, 89, 92, 112, 114, 118, 119, 120, 122, 123, 124, 125, 126,
127, 128, 135, 146, 147, 148, 153, 154, 160, 168.

Union of adjacent bones from inflammatory changes, 146, 147, 154,
155, 160, 188.

Rieketty curvature of, 85, 87, 103, 104, 105, 142, 143, 144.

4. — Flat bones —

Distortion of — from rickets, 58.

5. — Stumps —

Necrosis of, 113, 133, 134, 136, 180, 181, 182.

6. — Joints —

Diseases extending into, 71, 74, 78, 79, 80, 89, 97, 98, 99, 112, 114,
126, 127, 128, 135, 147, 148, 158, 159, 160, 161, 168, 185, 186,
187, 188.

7. — PYiEMIA —

After operations on bones, 69, 70, 71, 72, 74, 92, 118, 119, 120,
123, 150.

8. — Amputation —

For caries or necrosis, 98, 99, 134, 170, 178, 185, 188.

For osteo-myelitis, 69, 72, 73, 92, 119, 123.

For scrofulous disease, 106, 187.

C.— PATHOLOGICAL : Illustrating the nature of the disease.

1. — Hypertrophy of Bone, 1, 2, 3, 4, 5, 6, 7, 65, 66.

2. — Atrophy of Bone, 8, 141.

* Does not include all the specimens, but sufficient to illustrate the subjects above noted.

DISEASES OF THE BONES.

[series II.

3. — Periostitis, 13, 113, 114, 115, 149

4. — Nodes, 18, 145, 158, 162.

5. — Ostitis —

With formation of bone on surface and in compact tissue, 67, 79,
114, 116, 117,145, 146, 147.

With formation of bone in both compact and cancellous tissues,
107, 108, 109, 112, 125, 148

With expansion of the walls of the bone, and subsequent indu-
ration, 107, 108, 109, 110, 111, 148, 160.

Elongation from, 110, 112.

Closure of medullary canal in, 88, 107, 108, 109, 112, 148.

Syphilitic, 15, 18, 19, 65, 145, 149.

6. — Suppuration—

On surface of bone, 114. 116, 117.

In the interior (osteo-myelitis), 69, 70, 71, 72, 73, 74, 92, 118, 119,
120, 121, 122, 123, 150.

7. — Abscess of Bone, 56, 56a, 151.

8. — Ulceration or Caries—

Simple, 75, 76, 77, 79, 88, 89, 97, 121, 129, 130, 152, 156, 157.
Strumous, 16(F), 99, 128(F), 161(F), 186, 186, 187-
Syphilitic, 4, 14, 15, 18, 19, 98, 125(F), 153(F), 162.

Of newly formed bone, 112, 148, 160.

9. — Necrosis —

Formation of the groove, 24, 134, 157-

Complete separation of sequestrum, 22, 84, 134, 167, 189.

Invagination of the sequestrum, 76, 131, 135, 163, 166, 167, 177.

In abscess and ulceration, 100, 114, 169, 178.

From syphilis, 15, 20, 21, 30, 190.

After malarious fever, 36, 38, 40, 41, 42, 170, 177.

After mercurial salivation, 55.

After small-pox, 90.

Exfoliation of outer layer, 40, 90, 165, 169, 173, 174, 175.
of whole thickness, 25, 31, 34, 35, 37, 38,39,81,84,

133, 171, 172, 176, 177.

Exfoliation of whole circumference, 29, 82, 180, 181.

10. — Exfoliated portions, 25, 34, 36, 38, 40, 81, 82, 84, 100, 132, 133,

134, 171, 172, 173, 174, 175, 176.

11. — Rickets, 58, 85, 87, 103, 104, 105, 142, 143, 144.

12. — Fatty degeneration, 96, 183, 184.

13. — Hydrocephalus, 2.

14. — Tumours and outgrowths —

Mixed osseous, 28, 44, 49, 52, 62, 86a, 93, 101, 140.

Exostoses, 26, 27, 48, 85, 137.

Hyperostoses, 566, 86, 139, 162.

Osteophytes, 85, 138.

15. — Cysts, 45, 46, 47, 50, 51.

16. — Natural amputation after gangrene, 134.

IKBIE8 II.]

DISEASES OF THE BONES.

I Enormous concentric hypertrophy and increased density of the
calvarium. In the situation of the frontal eminences the section
is very dense, and measures about half an inch in thickness.
The bone is also considerably thickened at the parietal promi-
nences. This increased density is seen to be chiefly due to
hypertrophy of the diploe.

2. Hydrocephalic head. The eccentric hypertrophy of the bones ol the
skull, and the remarkable development of Wormian or super-
numerary bones are well seen. The latter are found in double
rows, mterdigitating, in the lambdoid, sagittal, coronal, and both
squamous sutures. One hundred and twenty-three of these
accessory bones can even now be counted lying between the
sutures, and many have dropped out and been lost. The largest
are situated posteriorly, in the situation of the corresponding
fontanelle, and also laterally, at the junction of the anterior
inferior angles of the parietal bones with the greater wings of
the sphenoid. A very large Wormian bone, moreover, occupies
the situation of the anterior fontanelle. It measures 2" x If''.
A portion of the vault of the skull, especially in the left
temporal and superior occipital regions, is wanting. The cir-
cumference of the skull measures twenty-eight inches ; longi-
tudinally (from root of nasal bones to occipital protuberance)
twenty-two inches ; across, from one mastoid process to the
other, twenty and a half inches ; base of skull (from nasal
process of superior maxillary bones to posterior margin of
foramen magnum), four and seven-eighths inches. From these
measurements it will be seen that the bulk of the hypertrophic
development of the bones is due to the expansion of those
composing the vault of the cranium, while those at the base
are about normally developed.

3. “ A portion of the calvarium, exhibiting great hypertrophy of the

frontal bone. Both tables and the intervening cancellated
structure are equally affected, and there is superficial caries of
the external and internal surfaces.” (Ewart.) No history.

4. Syphilitic hypertrophy of the bones of the skull. From a native

male (Abdoola), a Madrasee. The hypertrophy affects chiefly the
frontal and left parietal bones, and, as may be seen from a
triangular section made through the whole thickness of the
former, is produced chiefly by an overgrowth of the diploe
between the inner and outer tables. Viewed externally, the
skull is also unsymmetrical, the left frontal and parietal regions
being more prominent than the right.

The occipital bone is greatly thickened, notably in the situation of the
Torcular Herophili. There are also four large Wormian bones
at the junction of the lambdoid and sagittal sutures (posterior
fontanelle). The whole of the inner surface of the middle fossa
cf the skull, and of the left frontal and parietal bones, has a
roughened, irregularly eroded, and also thickened appearance from
active inflammatory changes. In this situation a large gummy

DISEASES OF THE BONES

[series II.

tumour was found closely adherent to the bone and dura mater,
and pressing upon the left cerebral hemisphere

5. The vault of the skull, showing a greatly hypertrophied and

massive condition of the bones, especially of the frontal, which,
at its normal centres of ossification, is quite three-fourths of an
inch in thickness. This thickening is principally due to an
expansion and condensation of the diploe. Viewed from the
interior, the coronal suture is seen to be quite obliterated, and
the sagittal and lambdoid sutures nearly so.

The dura mater was unusually adherent : the anterior cerebral convo-
lutions flattened.

There was a small gummy growth at the junction of the left optic thala-
mus and corpus striatum, and thrombosis of the basilar artery. —
From a European female, aged 40,

( See further “ Medical Post-mortem Records,” volume I, 1875,
pp. 701-702.)

6. The anterior half of the skull cap, showing great concentric hyper-

trophy, probably syphilitic. The frontal bone is especially
thickened, and measures from half to three-fourths of an inch
at a distance of about two inches above the orbital arches. The
thickening is seen to be due to an expansion and development of
the diploe, which, in the fresh state, was rosy-pink in colour and
abnormally vascular.

The dura mater was unusually adherent to the hone in the frontal
region, and the inner surface of the latter (bone) a little rough,
irregular, and thickened, but the brain substance below was
normal. There were gummy growths in the liver, and contracted
and amyloid kidneys. — From a native woman, aged about 40.

(“Surgical Post-mortem Records,” volume I, 1877, pp. 381-82.)

7. Greatly thickened vault of the skull; the bone particularly solid

and hvpertrophied in the frontal region; probably syphilitic, —
From a European male, aged 45.

(See further “Medical Post-mortem Records,” volume III, 1879,
pp. 377-78.)

8. “Extreme atrophy of the calvarium. Both tables and the interven-

ing osseous tissue are remarkably attenuated, and the external
and internal surfaces are smooth and shining. The parietal and
frontal bones are not more than the tenth or eighth of an inch
in thickness.” (Ewart.) {Presented by Professor H. H Goodeve.)

9. “ Cal varium of a Hindu skull (found on the river hank near

Barrackpore), showing complete closure of the coronal, lambdoid,
and sagittal sutures. They are completely obliterated externally;
slight grooves indicate their position internally.” (Colles.)

10. Congenital syntosis of the occipital bone and atlas. The speci-

men was found among a number of other dried and detached
bones of the skull, in the dissecting-room collection, so that
the sex and age of the subject are unknown; but, judging from
the size and delicate structure of the occipital, it probably
belonged to a child or young adult. The atlas is completely
conjoined to the base of the occipital bone, except at the
posterior margin of the foramen magnum, where a narrow slit,

SERIES II.]

OF THE SKULL.

about half inch in length and three lines in breadth, intervenes.
The occipital has no condyles ; they are merged, as it were,
into the lateral masses of the atlas. The inferior articular
processes of the latter are normal. The anterior and posterior
condyloid foramina of the occipital are well-formed and distinct.
The anterior arch of the atlas is perforated by a rounded
foramen, immediately above the tubercle.

There is no evidence of any disease (caries, &c.) of, or around, the
conjoined bones.

XI. Microcephalic skull of an idiot, a native, aged about 11; height
four feet eight inches. The weight of the cerebrum was six
and a half ounces ; cerebellum, two and a half ounces; pons and
medulla, one-fourth of an once. The “ convolutions were rather
flatter than usual, and the middle lobe was less prominent than
usual below : otherwise the brain was normal.”

The greatest circumference of this skull is thirteen inches ; transversely,
from the root of one zygoma to the opposite, seven and a
quarter inches ; longitudinally, from root of nose to occipital
tuberosity, seven inches.

The occipital region is much flattened, and there is evidence of
inflammatory thickening of the inner table and diploe in this
situation. The lesser wings of the sphenoid are also unusually
thick and massive. The capacity of the skull is greatly
reduced ; the facial angle thrown forwards ; the superior maxilla
and incisor teeth very prominent. ( Presented by Dr. Loch,
Civil Surgeon, Bareilly.)

12. The calvarium of a “ half-caste woman ” exhibiting a depression
in the external table, the size of a half-crown piece. The edges
are smooth, rounded, gradually bevelled off'. The diploe has
been absorbed, and the internal table perforated, the aperture
in the latter being about the size of a fourpenny piece. At
this spot the pericranium and dura mater are blended together,
but the latter is not opened.

The depression in the vault is situated at the junction of the coronal
and sagittal sutures, and immediately above the superior
longitudinal sinus, the channel of which, however, remains
quite unaffected. This lesion is “ supposed to have been the
result of a fracture of the skull some years back, the gap having
been partially repaired by the deposition and organization of
lymph into a strong lamina of adventitious structure,” but
the appearances on careful examination leave scarcely any
doubt that the loss of osseous tissue and consequent gap has
been due to the growth and subsequent absorption or evacu-
ation of a syphilitic node. No Assuring or depression of the
inner table can be detected. ( Presented by Professor Norman
Chevers, m.d.)

13. Base of the skull from a case of cancrum oris following malarious
fever. The whole of the superior maxilla, as also the right
pterygoid process of the sphenoid, a portion of the body of this
bone, and the right half of the lower jaw, are rough, and were
found denuded of periosteum. The posterior ethmoidal cells and

DISEASES OF THE BONES

[series II.

those within the body of the sphenoid exhibited a very softened
and friable condition of their bony dissepiments. The middle
lacerated foramen and the foramen ovale had their bony margins
denuded, and the dura mater lining the same (continuous with
the external periosteum) was thickened, soft, pulpy, and of an
ash-grey colour. The dura mater investing the right middle
fossa was stained greyish-yellow, was thickened, and soft for the
space of about a square inch immediately above this spot, and a
corresponding portion of the brain substance was pulpified and
pinkish-grey. This consisted of the anterior extremity of the
middle cerebral lobe, forming the posterior and inner boundary
of the right fissure of Sylvius, The periosteal inflammation had
therefore spread by direct continuity of structure from the
exterior of the skull (through the middle lacerated and oval
foramena) to the internal dura mater and contiguous cerebral
substance. Towards the close of life there were cerebral symp-
toms, convulsions, &c.

14. Syphilitic caries and chronic ostitis of almost the whole of the

frontal bone, reaching downwards to the left malar, and outwards
into the temporal fossa. The bone is peculiarly and characteris-
tically eroded in small pitted circles, which are bordered by
slightly raised ridges of newly formed bone. The disease spread
to the interior of the skull, as may be seen by the roughened
state of the right half of the anterior fossa, and was evidenced
during life by the development of meningo-cerebritis, associated
with epileptiform fits, and the discovery, after death, of an abscess
in the right anterior cerebral lobe, immediately beneath the
inflamed bone and membranes.

15. Extensive caries of the frontal bone. On the right side the whole

of the external table and a portion of the diploe have disappeared,
and an excavation, about the size of a rupee, remains. It has
a slightly raised, roughened, and irregularly rounded margin.
On the left, central necrosis of a portion of the whole thickness
of the skull exists, — an islet of dead bone, surrounded by irre-
gular serpiginous, carious ulceration. Considerable hypertrophy
of the bone is observed where not thus affected. Although no
history is attached to this preparation, the conditions presented
appear to be undoubtedly due to syphlitic changes. ( Presented
by Dr. F. Oxley, of Singapore.)

16. 0 aries, leading to perforation of the skull. The central portion

of the frontal, the left half of the coronal suture (at its centre),
the interior extremity of the sagittal suture, and the posterior
margin of the left parietal, are the situations where the disease
has manifested itself: in addition to which, caries without
perforation of the left half of the frontal bone exists over a
space the size of an eight-anna piece, the external table and a
portion of the diploe having been absorbed.

These carious patches are said to have been found “lying under-
neath scrofulous tumours.” “ The sagittal, squamous, and
lambdoidal sutures are ossified.” {Presented by Dr. F. Oxley, of
Singapore.)

SERIES II. 1

OF THE SKULL.

•51

17. Caries (with perforation) of the adjacent borders of the frontal

and left parietal bones. “ Both tables have been completely
destroyed,” leaving an irregularly rounded opening rather larger
than a shilling.

The ulcerative process is much more marked and extensive in the
interior of the skull, and appears to have commenced there,
spreading gradually through the diploe, and finally reaching the
sui’face and producing perforation.

18. “ Superficial caries of the outer table of the left, and of a small

part of the right, parietal bone ; also of a very small portion of
the occipital bone. On the internal aspect of the frontal bone
there are several excavations, interspersed with osseous protu-
berances.” (Ewart.)

The changes are probably syphilitic. The internal nodes referred to are
symmetrical, being placed in exactly similar positions on either
side of the median line (groove for longitudinal sinus).

19. A portion of the calvarium of a native woman, showing a per-

foration as- large as a four-anna piece through the right parietal
bone, close to the sagittal suture, and encroaching upon the
longitudinal sinus below, the groove for which is very indistinct.
The bone is particularly firm and massive ; sutures all united.
The lesion was caused by the perforation of a syphilitic node
through the calvarium. The external table is bevelled and
carious for about half an inch round the margins of the opening,
and the internal table is similarly affected.

20. “ Necrosis of the bone forming the left frontal eminence and root
of the nose. The patient, a native, was admitted into hospital
with syphilitic ulcers on the forehead, which destroyed the peri-
osteum and caused necrosis of tlie frontal bone. On post-mortem
examination it was found that the ulceration had passed through,
and that the dura mater was adherent. A great quantity of
serum was lying between the dura mater and arachnoid, and in
the ventricles of the brain, which was generally softened, espe-
cially its anterior lobes.”

'1 he syphilitic character of the lesions, consisting of islets of necrosed,
but not absolutely separated bone, lying surrounded by irregular,
serpiginous, carious ulceration, is well seen in this specimen.

( Presented by Professor Allan Webb )

121. Necrosis of the root of the right pterygoid process of the
sphenoid, said to be the result of syphilis.

22. Necrosis of a portion of the frontal bone, immediately above the
right supra-orbital ridge. The sequestrum, about the size of a
rupee, is completely isolated, but remains in situ surrounded by
a deep groove of carious ulceration. “ There was found an
effusion of thick pus at the base of the brain, limited anteriorly
by the optic commissure, posteriorly by the inferior vermiiorm
process of the cerebellum, and laterally by the optic tracts,
crura cerebri, and the sides of the pons Varolii and medulla
oblongata. There was also pus between the skin and necrosed
bone, communicating with the interior of the skull.” ( Presented
by Professor Allan Webb.)

DISEASES OF THE BONES

[series II.

23. The calvarium, with the dura mater, and a portion of the brain

from the body of W. J. S., aged 43, who died from abscess
of the brain. He was admitted on the 18th July 1870 with
a neglected contused wound of the scalp (near the left parietal
prominence), which had been followed by necrosis of the sub-
jacent bone. The patient became hemiplegic (right) on the
30th July, and on the 31st, aphasic. A circumscribed piece of
the necrosed bone was removed by trephining on the 1st August,
after which there was recovery of power in the limbs, and partially
also of speech. This lasted until the 18th August, when the
man again became hemiplegic. Another portion of bone, near
the site of the first .trephine hole, was now removed, but with
no benefit, the patient dying on the 23rd, or seven days after this
second operation. The calvarium on its outer surface was
found quite carious and necrosed, the dura mater unusually
adherent, and partially covered with sprouting granulations.
The brain substance had begun to protrude through the aperture
made by the trephine, &c. “ An abscess, the size of a hen’s egg,

was discovered in the left lateral hemisphere, near the left
fissure of Sylvius. The left corpus striatum and optic thalamus
were softened on the surface, shaggy in appearance, easily washed
away by a gentle stream of water, the optic thalamus, indeed,
partly broken down.”

24. “ Anterior part of calvarium of an East Indian woman, "aged 38,

admitted on 4th July 1867 with a lacerated wound in the
forehead: died 25th July. The portion of bone corresponding to
the wound was found stripped of periosteum, and a groove of
demarcation (necrosis) was beginning to form between it and the
sound bone. This is well seen in the preparation. There was
softening of the corresponding portion of the dura mater, and
pus effused between the pia mater and the brain, for a space of
two inches antero-posteriorly, by half an inch laterally, the layer
of pus being one-twentieth of an inch thick. The pus was
effused on the upper surface of each hemisphere close to the
longitudinal fissure, the centre of the effusion corresponding to
the exfoliation of the outer table.” (Colies.)

25. Two portions of exfoliated (necrosed) bone from the frontal region

of the skull. Each piece is about an inch square, of irregular
outline, and presents a curious honeycombed and perforated
condition, with thinning of the compact tissue of the outer
and inner tables, and almost complete absorption of the inter-
vening diploe.

26. “ Section of an osseous tumour removed from the left cheek of

a native of Bengal.” (Ewart.) The growth is about the size
and shape of a walnut, and appears to be a spongy osteoma.
(jF resented by Professor Brett.)

27. An ivory exostosis, about the size of a nutmeg, from the posterior

aspect of the skull. It has developed from the occipital bone,
a little to the left of the median ridge, and below the tubercle.
Was found on 'post-mortem examination of a native female, aged
30, who died in hospital of puerperal pyaemia. The little

SERIES II.]

OF THE SKULL AND FACE.

growth litis been bisected, and presents a smooth, very haul, dense,
and ivory-like structure.

28. The anterior half of the base of the skull of a native lad, aged
17, preserved as a dry preparation to show the ravages com-
mitted upon the osseous structures by a malignant growth (a
round-celled sarcoma), which had developed in the right spheno-
maxillary fossa, and filled the right nares, antrum, &c.

It will be seen that the body of the sphenoid, and the posterior half of the
right ethmoidal cells are deeply and irregularly excavated,
and present a rough, cribriform appearance. The os planum of
the ethmoid on the right side, and the orbital plate of the
superior maxillary on the same side, have been respectively
displaced outwards and upwards. The tumour possessed pro-
cesses, which took different directions. One of them entered
the interior of the skull through the spheno-maxillary fissure,
and subsequently through the anterior lacerated foramen,
hooking round a plate of bone which appears to be the right
lateral surface of the sphenoid. This prolongation made its
appearance in the middle fossa of the cranium, converting the
anterior lacerated and foramen rotundum into one large irregular-
outlined aperture, as seen in the preparation. A second process
perforated the inner plate of the right pterygoid process of the
sphenoid at its root. Both the lesser wings of the sphenoid were
also involved by the growth.

On viewing the base of the skull from above, several irregular-out-
lined openings or perforations are seen situated in the body of the
sphenoid, in both lesser wings, and in the right great wing.

29. Exfoliation of the right half of the lower jaw, the result of

necrosis. The exfoliation consists of a delicate, thin, hollow
shell of bone, comprising the right ascending and transverse
rami, with the condyloid and coronoid processes. No history.

30. “Skull and bones of the face, showing complete destruction of
the bones of the hard palate” (superior maxillary, both palate
bones, and the vomer) “ from syphilitic disease.” (Ewart.)

( Presented by Moulvi Tamez Khan Bahadur.)

31. “ Necrosis of the alveolar processes en masse of the upper and

lower jaw.” (Ewart.)

32. Necrosis of the left half of the lower jaw. No history.

33. N ecrosis of the upper two-thirds of .the body or horizontal portion

of the lower jaw.

“ The whole of the jaw was removed, and the patient did well after the
operation. The disease was of eight months’ duration, not the
result of mercury or syphilis. In a native of Parway, aged 30.”
{Presented by Professor Allan Webb.)

34. Exfoliated portions of a necrosed lower jaw, with five teeth

in situ. No history.

35. The right half of the lower jaw of a child in a state of complete

necrosis, liemoved by operation-

36. “ Sequestrum from the lower jaw of a Hindu boy, aged eight

years, with one of the deciduous molars in situ , and the cavity
of reserve for the corresponding bicuspid laid open by the disease.

DISEASES OF THE BONES.

[series ir.

Necrosis caused by malarious cachexia of five years’ standing.”
(Colies.)

37. “Necrosed portion of the lower jaw, removed from a native male

named Nundo Lai Pal.” No history. It consists of the right
half of the jaw, from just below the coronoid and condjdoid pro-
cesses to the symphysis. The external surface is rough and bare,
the internal deeply furrowed and eroded, the whole bone white
and dry. The teeth have all dropped out of their sockets.

38. Necrosis of the lower jaw from “ cancrum oris,” following an

attack of remittent fever. The preparation consists of the right
half of the transverse portion of the jaw, from the angle to the
symphysis. From a native male, aged 25.

39. Necrosis of the greater portion of the left half of the lower jaw,
. including the body and a portion of the ascending ramus. From

a native.

40. Exfoliation of the external lamina of the osseous tissue of the
lower jaw (right half), from a native bov, aged about 14, suffering
from cancrum oris and hypertrophy of the spleen, &c.

41. The articular condyle, and a portion of the descending ramus of

the right half of the lower jaw, removed on account of necrosis,
from a native male patient, aged 30. The disease had set in
after an attack of “fever,” lasting intermittently for eight
months.

The bone is quite dry, brownish-white, and destitute of periosteum.
(. Presented hy Professor S. 13. Partridge, f.r.c.s., &c.)

42. Extensive necrosis of the whole of the lower jaw, associated with

chronic malarial cachexia. From a native male, aged 30, who
died in hospital of pneumonia, &c.

43. Necrosis of almost the whole of the lower jaw .of a native (male),

aged about 30. The left half of the jaw has principally
suffered ; several small exfoliations, of irregular size and shape,
have separated from the outer surface of both the horizontal
and ascending rami, and, on the inner aspect of the latter, there
are numerous furrows and pits, with general roughening and
thinning of the bone; while here and there, on both inner and
outer surfaces of the jaw, there are traces of attempts at new
bone being thrown out in the form of slightly prominent
rough “ bosses ” or projecting processes. The sockets of all
the& molar teeth on the left side are exposed, and the
alveolar margin considerably absorbed. The patient died from
erysipelas.

44 “ The osseous skeleton of an osteo-sarcoma of the lower jaw.’

(Ewart.) .

45. “ Anterior part of the antrum Highmonanum, removed lor disease

of the jaw.” (Ewart.)

The portion of the antrum referred to has evidently undergone
expansion, the osseous wall becoming thin and shell-like. It
is lined by a soft velvety membrane, and probably constitutes
a portion of a cyst which had developed in this cavity.

SEEIE9 II.]

TUMOURS OF THE LOWER JAW.

46. “ A cyst of considerable size, occupying a portion of the body

of the left half of the lower jaw. Where that joins the ramus,
the entire thickness of the bone is destroyed.” (Ewart.)

What the contents of the cyst were, is not recorded. It is empty now,
is about the Nize of a duck’s egg, and situated just below the
alveolar border, in the substance of the body and ascending
ramus of the bone, expanding the latter both anteriorly and
posteriorly. The fangs of the molar teeth reach into the
cyst, but these teeth are firm, normal in number, and healthy-
looking.

47. A cystic tumour of the lower jaw, from an up-country native,
a Hindu, aged 32. The preparation consists of the left half
of the lower jaw removed by disarticulation, and section at the
symphysis. The posterior two-thirds have been converted into a
thin-walled cyst, the size of a large orange, composed of firm
connective tissue (periosteum), with plates of calcified material
imbedded in it. The anterior third of the alveolar margin
below the bicuspid teeth is expanded so as to form an irregular-
outlined cyst with bony walls, filled wit-h brownish, sabulous
material, which, under the microscope, consists principally of
flattened plates of cholesterine and altered blood, with "free
granular and molecular fat.

Although the three molar teeth are fully developed, and the fangs of
the other teeth in the alveolus appear to be sound, yet the
general characters of this cystic tumour seem closely allied to
the so-called congenital or dentigerous cysts so frequently found
in connection with the jaws, and probably the preceding pre-
paration (No. 46) is a similar specimen. ( Presented by Pro-
fessor Kenneth McLeod, m.d.)

“ Exostosis of the lower jaw of a native, aged 27 years. The
disease was of ten years’ standing. The whole of the growth with
a portion of the jaw was successfully removed.” (Ewart.)
exostosis is trilobulated, and projects from the alveolar border
of the left half of the horizontal portion of the lower jaw.
Two incisor, one canine, and two bicuspid teeth, are seen to be
involved in the growth. The section made shows the structure
of the latter to consist almost entirely of hard, condensed, ivory -
hke, osseous tissue.

The. bony shell of an osteo-sarcoma of the lower jaw. The prepa-
ration consists of “ the left half of the lower jaw of a Chamar
(native), aged 24, excised for a tumour involving the bone
rom the condyle nearly to the symphysis. The tumour itself
broke down altogether after a few dav s’ maceration, leaving only
the bony shell in which it was enclosed.” (Colics.)

(bee further, Indian Medical Gazette , November 1866, p. 339. /’re-

sented by Dr. W. P. Dickson, Civil Surgeon, Rohtuk.)

A large fibro-cystic tumour of the lower jaw. It consists of a
senes of cysts, varying in size from that of a small orange
to that of a pigeon’s egg, their walls composed of very dense
^hlammatod fibrous tissue, with a smooth glistening
epithelial lining on the inner surface. Each cyst is complete

48.

The

49.

50.

DISEASES OF THE BONES

[series II.

in itself [unilocular). The contents consist of a soft, reddish-
white, opaque, glairy fluid, which, under the microscope, exhibits
large quantities of fat, molecular and granular, very large
and numerous superimposed plates of cholesterine, altered
blood-cells and pigment, and a few withered, old epithelial
scales.

The horizontal ramus of the jaw is hollowed out so as to form the thin
eggshell-like investment of two of the larger and two of the
smaller cysts just described. — From a native male aged about 32.
The growth is said to have been of nearly 20 years’ duration.
(. Presented hi) Professor S. B. Partridge, f.r.c.s., &c.)

51. Another similar tumour from a native male, aged 35, stated to

be a growth of two and a half years. It occupies the right
half of the lower jaw, the horizontal portion of which is
hollowed out to eggshell-like thinness. The growth is fibro-
cystic. Three of the larger C}7sts are bounded by osseous
walls (the expanded jaw) ; the others have firm, tough, fibroid
walls, lined on the interior by a layer of flattened epithelium.
The cysts are all unilocular, and do not communicate with
each other. They vary in size from a walnut to a betelnut.
They contain soft, reddish-white, grumous, and glistening
material, which, under the microscope, is seen to consist of
much fat, molecular and granular; large and numerous
superimposed plates of cholesterine; blood-cells in abundance,
both red and white ; and a little altered (fatty and withered)
epithelium.

The portion of the jaw involved, together with the whole of the tumour
was removed by operation.

52. A fibrous-looking tumour, with a portion of the lower jaw (left

side), removed from a native male, aged 30. It is said to be a
growth of two and a half years.

The portion of the jaw removed consists of the symphysis and
left horizontal ramus as far as the angle. A smooth-surfaced,
highlyTobulated growth is seen to spring from the alveolar
border. It surrounds the whole of this border, from the angle
of the jaw to the canine teeth, but beyond this the alveolus is
free. The tumour also pressed backwards and upwards into the
mouth. It here displaced the tongue, and constituted a formid-
able-looking growth in the floor of the buccal cavity, but the
tongue itself, and the greater portion of the mucous membrane
of the mouth, were not involved.

The tumour, when fresh, had a pinkish-white colour, but is now
more opaque and brownish from soakage in spirit. It has a
firm yet elastic consistency ; no distinct capsule. On section is
fibrous-looking, that portion growing from the gum being more
densely fibrous than that projecting into the mouth.

At the angle of the jaw, half imbedded in the tumour, are the first
molar and second bicuspid teeth ; more anteriorly, where the
alveolar border is free, the left canine and incisors are seen, and
also the incisors, canine, and first bicuspid of the right side ;
altogether nine teeth, very much crowded together.

SERIES II.]

OF THE JAWS AND TEETH.

The bony portion of the lower maxilla (below the alveolus) does not
appear to be affected, the growth remaining confined to the
gum, and extending thence to the periosteum on the inner and
outer aspects of the jaw.

On microscopic examination, its structure is seen to consist of fibro-
cellular tissue, the cell-elements predominating. These are small,
round, and nucleated. The fibrous tissue is scanty and delicate,
irregularly and sparingly distributed ; but the most remarkable
character of the growth is the excessive development and
amplification of the normally existing glandular structures of the
gum. In every section, tubular and racemose developments are
found, lined by cylindrical epithelium, or dilated and filled with
exuberant shred, latty epithelium. Blood-vessels are moderately
numerous.

Trie tumour is therefore an “ epulis ” of rare variety ; it may be termed

53.

54.

55.

56.

an “ adeno-sarcoma.” ( Presented by Professor Gayer.)

showing the effects of caries in

“ A collection of permanent teeth
destroying the crown and dentine.” (Ewart.)

A preparation exhibiting various degrees of caries affecting the
permanent teeth of both the upper and lower jaws. (Presented bu
Professor W. T. Woods.)

“ A sequestrum, consisting of the greater part of the alveolar
process, with several teeth, from the lower jaw of a patient
affected with profuse mercurial salivation.” (Colies.)

A preparation showing inflammation of the fang of the right
canine tooth, with the formation of an alveolar abscess, which
has extended into the antrum, and produced considerable dilata-
tion or expansion of that cavity. A soft, velvety, pyogenic
membrane is still to be seen lining the inner surface of the

56a.

56b.

57.

58.

59.

abscess cavity
“ Alveolar abscess.”
attached to the
( Presented by Professor W

The
apex of

the abscess is seen
lower molar tooth.

Found

small sac of
the fang of a
. T. Woods.)

Hyperostosis of a lower molar tooth. The fangs are seen
encased in false bone, on account of an exuberant growth of

(Bie cementum.” ( Presented by Professor W. T. Woods.)

“ A lower incisor tooth, surrounded by an enormous accumulation
ot tartar. The tooth was quite loose. From a male Hindu
aged 60.” (Colies.)

Sternum from a case of rickets. The bone is bent backward s
npon itself, so as to present an acute angle anteriorly.

Congenital union (syntosis) of two ribs,— the second and third of
the right side. The sternal extremities are separated and distinct ;
halt an inch from these a broad band of osseous tissue, three-
iourths of an inch in length, unites the two ribs. They are again
separated by a gap of about two inches, and then the iowor rfb is

1 w the upper- 0n]y a sinSle tuberosity and head exist,
ami the latter, with a solitary whole facet for articulation with
the vertebral column.

among the dissecting-room collection of bones. No
obtainable.

history

58 DISEASES OF THE BONES [series ii.

60. A couple of ribs, between which, on the inner side, is a conical
or nipple-shaped growth, which unites their adjacent margins.
The growth consists of imperfectly ossified cartilage, and is
invested by the periosteum common to both ribs at this point.
(Presented b) Professor C. 0. Woodford, m.d., &c.)

61. Necrosis of the fourth and fifth ribs and their costal cartilages, on

the left side, close to the sternum. An opening in the super-
jacent skin, leading down to the diseased tissues, is shown in the
preparation, and also the great thickening and condensation of
the combined pleura and pericardium in this situation. All com-
munication with the pleural and pericardial cavities was thereby
prevented. Small portions of necrosed bone and cartilage were
removed by operation during life. The patient, a native male,
aged 40, died, however, of lobar pneumonia of the left lung. This
organ was found firmly fixed to the parieties of the chest, and
solid.

62. Sternum, with the sternal ends of the ribs, from a case of diffuse

melanosis, — an East Indian male, aged 44.

The sternum has three irregularly nodulated growths; two of them,
about the size of a walnut, occupy the whole thickness of the
bone beneath the periosteum, having caused absorption of the
osseous tissue ; the third, about half the size of the above, does
not perforate the bone.

The structure of these growths is that of melanotic carcinoma (enkepha-
loid), and similar developments were found in the liver, kidneys,
brain, &c.

63. “ Superficial caries of the . acromial and sternal ends, and of a

portion of the inferior surface of the right clavicle.” (Ewart.)

64. Extensive caries of the right scapula, affecting chiefly the
glenoid cavity, which is very rough and eroded, but extending also
to the axillary border of the bone, and involving both the
acromial and coracoid processes. No history. The scapula
was received “ from the dissecting-room.”

65. Hypertrophy of the lower half of the right humerus. The

thickening of the shaft, especially in its transverse diameter,
is well seen, and is the result of syphilitic ostitis.

66. Hypertrophy of the shaft of the right humerus. The density

and weight of the whole bone have considerably increased. The
hypertrophy affects chiefly the upper half of the shaft, which is
here especially massive and thick. No increase in the length of
the bone has taken place.

67. A specimen showing thickening and roughening of the shaft

of the left humerus at its lower third, with nodular enlargement
of the bone in this situation, due to ossiiic deposit, the result of
ostitis and periostitis, and probably syphilitic.

68. The lower articular end of the left humerus, with about an inch

of the adjacent portion of the shaft, resected on the tenth day
after an amputation through the elbow-joint, on account of a
myeloid tumour of the forearm. The amputation-flaps having
sloughed, this portion of the humerus was left exposed and
bare, and had to be excised. The articular cartilage has been

SERIES II.]

OF THE UPPER EXTREMITY.

almost completely absorbed, and the bone above it is destitute
of periosteum ; was highly inflamed, and presented a very vascular
condition in the fresh state.

69. “ Longitudinal section of the upper third of the humerus of

a native, aged 32, showing disintegration of the cancellated
texture from osteo-myelitis.” (Ewart.) In the recent state,
the whole of this structure was found infiltrated with pus.
“ From a patient whose arm was removed at the shoulder-
joint, and who died from pyaemia.” ( Presented by Professor
Fayrer.)

70. The upper half of the humerus, showing the effects of osteo-
myelitis. From a native male patient, who died from pyaemia
after amputation through the middle of the arm. The lungs
contained “ numerous abscesses, varying in size from a pea to a
pin’s head.” (Colies.)

71. Preparation showing (1) excision of the elbow-joint for extensive

caries and necrosis of the articular ends of the humerus, ulna,
and radius, which are seen to be rough and eroded, verjr light
and spongy in texture, and almost destitute of the investing
cartilage. (2) The head and shaft of the humerus, removed
after death, exhibiting the results of extensive osteo-myelitis,
which followed the operation on the elbow-joint. This was
associated also with a large abscess beneath the pectoralis
major muscle. The destructive changes in the shaft of the
bone have resulted in separation of the superior epiphysis from
it, while the medullary canal is occupied by soft, suppurating,
highly vascular (in fresh state) material.

The patient, a native child, aged 12, died from pyaemia one month
after the operation. (Presented by Professor Fayrer.)

72. Osteo-myelitis of the left humerus. From a native woman,

aged 25, whose forearm had been amputated (at the elbow-
joint) for a myeloid sarcoma, involving the upper portions of
the radius and ulna. The flaps sloughed, and the lower end of
the humerus became bare and exposed for about two inches.
This was resected, but followed by constitutional symptoms
(fever, great prostration, &c.), and a secondary amputation neces-
sitated at the shoulder-joint. Osteo-myelitis of the entire shaft
of the humerus was diagnosed during life, and is demonstrated
in the preparation.

A longitudinal section through the bone shows (1) the remains of a
protruding fungous mass of the medulla at the lower end of the
canal ; (2) the rest of this space occupied by soft, purulent, and
(in the fresh state) highly vascular medullary substance ;
(3) the cancellous head of the bone rarefied, and filled with
similar pulpy, purulent material ; (4) the endosteum and
periosteum removed for a considerable distance upwards from
the section of the lower end of the shaft, leaving rough and
bare bone. The patient died on the seventh day after the last
operation.

Multiple abscesses (pysemic) were found in the lungs and liver. The
spleen was enlarged and congested. Iioth pleura? were inflamed,

60 DISEASES OF THE BONES [series ii.

and contained between them about eight ounces of sero-purulent
fluid. ( Presented by Professor H. C. Cutcliffe.)

73. Osteo-myelitis of the left humerus, following the operation of

excision of the elbow-joint for disease. Death took place not-
withstanding the limb was amputated at the shoulder-joint. —
From a West Indian (Negro), aged 30.

The preparation exhibits the head and about two inches of the shaft of
the humerus bisected longitudinally’. The periosteum is highly
vascular and thickened, peels off readily from the bone, which
is seen to be quite bare and rough (necrosed). The cancellous
tissue is much softened, and freely infiltrated with disintegrat-
ing, purulent medullary material.

74. The right humerus, with portions of the radius and ulna, from a

case of resection of the elbow-joint for disease, in a native male,
aged 40, who died from acute septic peritonitis after the oper-
ation.

The humerus has been divided vertically so as to expose the medullary
canal. This is seen to be acutely inflamed, the medulla soft,
flickering, of a bright cherry-red colour. The cancellous tissue
of the head of the bone is similarly affected (osteo-myelitis).

For an inch and a half above the resected end of the humerus the bone
is bare and rough, denuded of both periosteum and endosteum.
The latter, indeed, seems to have separated from the interior of
the bone for about six inches. A plug of sloughy-looking,
putrescent medulla was found, on post-mortem examination, pro-
truding for half an inch from the medullary canal. The rest of
this substance (medulla), examined microscopically, was found
rich in blood-corpuscles, and, in addition, its proper structure
(small, round, mono-nucleated cells and giant cells) freely infil-
trated with fat and nuclei (bioplasts), and containing also many
cells, which, on the addition of acetic acid, became granular and
exhibited two or three small distinct nuclei, i.e. pus-corpuscles.
These appearances indicate acute inflammatory changes just
falling short of diffuse suppuration.

75. “ Caries of the upper portion of the (left) humerus.” (Ewart.)

No history.

76. Caries of the head of the left humerus. A small portion of the

outer layer of the bone is also necrosed, and the sequestrum was
enclosed or invaginated by disintegrating osseous tissue.

77. Caries and necrosis of the head and upper third of the shaft of

the right humerus, “ with complete separation of the former from
the shaft. Caries also of the lower extremity, and of the
articular ends of the radius and ulna.” (Ewart.) ( Presented by
Professor II. O’Shaughnessy.)

78. Extensive caries of the lower end of the right humerus, and of the

adjacent articular surfaces and upper portions of the shafts of the
ulna and radius. The bones of the carpus, metacarpus, and
phalanges are also similarly affected. No history.

79. “Caries of the bones forming the left elbow-joint.” (Ewart.) The

head and neck of the radius are a good deal thickened by the
deposit of new bone.

SERIES II.]

OF THE UPPER EXTREMITY.

80. Necrosis of the lower extremity of the right humerus, resulting in
destruction and removal of the articular surface and a portion
of the external condyle. A good deal ot new bone has been
thrown out over the remains of the condyles, and the density and
weight of the bone here have considerably increased.

81. A portion of necrosed bone, about two and a half inches in length,

and comprising the whole thickness of the shaft, removed from
the right humerus. {Presented by Professor Fayrer.)

82. An exfoliation from the shaft of the humerus, about an inch and a

half in length, and consisting of the necrosed compact tissue or
cortical layer of the bone. No history.

83. “ Necrosis of a portion of the head and upper part of the shaft of

the humerus. ” (Ewart.) {Presented by Professor Edward Goodeve.)

84. A sequestrum, about five inches in length, and comprising a con-

siderable portion of the entire thickness of the shaft of the
humerus, removed by operation from the arm of a native boy.
{Presented by Professor Fayrer.)

85. A preparation exhibiting two spongy exostoses at the upper part of

the right humerus. The larger one is placed externally, springing
from the surgical neck of the bone, and has a well-defined
constricted pedicle. The smaller one is flattened and tuberous,
is situated about two inches below the head of the humerus,
projecting from the inner margin of the shaft, and is grooved
on its anterior surface.

The ulna is foreshortened, and terminates in a pointed extremity
about an inch above the wrist-joint. Small osteophytic processes
surround the bone here, and a larger growth, apparently of the
same character, springs from the interosseous border, about two
inches above the inferior ulnar extremity. The head of the
radius is elongated, tuberculated, and articulates with the exter-
nal condyle of the humerus, not by its summit, but by its inner
margin.

The superior extremity of the ulna and the inferior extremity of the
humerus are expanded and large. The latter bone is curved
inwards, the shafts of the radius and ulna outwards — and also
flattened from before backwards. These changes are probably
due to rickets.

86. A foliaceous, exuberant outgrowth of new bone (hyperostosis)

from the lower extremity of the humerus, the compact tissue
of which is considerably thickened, and seen to be directly con-
tinuous with the new growth.

86a. The right humerus from a case of diffuse melanosis, — an East
Indian male, aged 44, showing dark sooty deposits in the
cancellous osseous tissue of the upper and lower extremities,
as revealed by the longitudinal section which has been made
through the bone. The shaft of the bone is not affected. The
structure of the morbid deposits is that of enkephoid carcinoma,
and similar growths were found in the liver, kidneys, brain, ribs,
and sternum {see prep. 62), &e. (“ Medical Post-mortem

Records,” vol. I, 1873, p. 16.)

G 2

DISEASES OF THE BONES

[SEEIES II.

87. “ Bones of the forearms twisted, shortened, and atrophied, with a

certain degree of softening. The bones of the lower extremities
were similarly affected. From a subject in the dissecting-room.”
(Ewart.) The radius and ulna of the right forearm are only
a little more than half the size of the corresponding bones of the
left forearm. In each case these bones are curved outwards,
the curvature in the left radius and ulna being much more
marked than in the right. The left ulna is also foreshortened,
and ankylosed posteriorly to the trochlear cavity of the humerus.
The superior extremities of both ulnae, and the inferior extremi-
ties of the radii, are expanded and disproportionately large.
The lower end of each humerus is also greatly expanded, flat-
tened from before backwards ; the internal condyle remarkably
prolonged and thick. The head of the left radius is elongated,
drawn out in the form of a rounded process with a tuberculated
extremity, which lies behind the elbow joint, and is about an
inch and a half in length. All these changes in the bones are
due to rickets.

88. “ Caries of the shaft of the ulna. The bone presents a worm-eaten

appearance, and is somewhat thicker than natural.” (Ewart.)
The medullary canal has been almost obliterated.

89. Caries of the superior extremity and upper third of the shaft of
the right ulna. No history.

90. Three sequestra — each from three to four inchesin length — removed
from the bones of the forearm of a young native lad, who,
during convalescence from small-pox, was attacked with acute
ostitis of the radius and ulna, ending in extensive necrosis of the
shafts of these bones.

91. The upper half of the right radius and ulna, from a patient who died

from pyaemia following amputation of the forearm. The bones are
seen to be almost denuded of periosteum, and superficially necrotic.

“ There was no osteo-myelitis, but the venae commites of the
radial and ulnar arteries were filled with pus up to their junction
with the axillary, where there was a slight recent non-adherent
coagulum.” (Ewart.)

92. Osteo-myelitis of the right radius and ulna, following upon an

amputation at the lower third of the forearm for a gunshot
injury to the palm of the hand. A longitudinal section has
been made through both bones, showing suppurative inflamma-
tion of the medulla, extending into the cancellous tissue of the
upper extremities of these bones. A secondary amputation
was necessitated and performed at the lower third of the arm ;
the humerus was found healthy. (Presented by Professor
Fayrer.)

93. “ Osteo-sarcoma connected with the (right) ulna and wrist joiut.”

(Ewart.) ( Presented by Professor II. O’Shaughnessy.)

94. Inflammation of the middle phalanx, and proximal phalangeal
articulation of the finger, resulting in thickening and superficial
necrosis of the former, and denudation of cartilage from the
articular surfaces of the latter. The distal phalangeal articu-
lation is healthy.

SERIES II.]

OF THE UPPER EXTREMITY.

95. Caries of the pisiform, unciform, and trapezoid bones of the left

carpus j as also of the metacarpal and first phalangeal bones.
No history.

96. “The left hand of a Punjabi boy, aged 12, with the metacarpal

bones degenerated into 'fat. History: About three years ago

the patient noticed that- his hand began to itch and be painful,
and it afterwards swelled a good deal. It thus commenced
with inflammatory symptoms. Poultices were applied, but
the swelling suppurated, and the opening never healed. Other
apertures formed, becoming converted into sinuses: the discharge
partly sanious, partly purulent. There were twelve of these
sinuses. Was treated by various native quacks, but without
advantage.” Amputation of the hand just above the wrist was
performed by Dr. F. F. Allen, 2nd Goorkha Regiment, at the
charitable dispensary, Rawal Pindi. Not only the metacarpal
bones, but those of the carpus, the phalanges, and the radius
and ulna, are all highly infiltrated with fat, and cut most readily
with the scalpel. There is thickening, with superficial caries
and central necrosis (at the head) of the metacarpal bone of the
index finger; caries also of several bones of the carpus, &c., so that
probably this has been the primary disease, and the fatty degen-
eration only consecutive to inflammatory changes, and princi-
pally to prolonged disuse of the hand, which the history of the
case indicates. ( Presented by Dr. R. T. Lyons, Civil Surgeon,
Rawal Pindi.)

97. Caries of all the bones of the right carpus, of the bases of the

metacarpal bones, and of the articular ends of the radius and ulna,
with complete disorganization of the wrist-joint. The specimen
was taken from an aged Hindu, who was brought to the hospital
in a very low condition. He died from exhaustion nine days
after admission, and before any operation could have been safely
performed.

98. Caries of the left carpus, apparently syphilitic. The carpal bones
are all softened, rarefied, and very spongy in structure ; their
surfaces eroded and roughened. The disease has extended also
to the radius and ulna. The articular surface of the former is
much hollowed out, and from both anterior and posterior surfaces
of the bone here stalactitic processes of newly-formed bone have
been thrown out in an irregular manner. The ulna shows
similar changes on its posterior aspect, and the shafts of both
bones for their lower thirds exhibit much thickening, with, at
the same time, caries and erosion of the compact outer layer.

There were numerous sinuses on the dorsum of the wrist -joint, leading
down to the diseased bones. Amputation was performed at the

r ^ middle third of the forearm.

Ihe patient, a young native adult (male), had a hard chancre six
years previously, followed by secondary skin eruptions ; the last
attack of the latter only six months prior to his admission into
hospital.

*99. Extensive caries of all the bones of the left carpus, of the
lower extremities of the radius and ulna, of the bases of all five

DISEASES OF THE BONES

[SEBIES II.

metacarpal bones, and of the heads of the fourth and fifth, and, to
a slight extent, of the third metacarpal bones. A little new bone
has also been thrown out over tlie posterior grooved surface of
the lower end of the radius. — From a native male, aged 35.
Amputation performed at the lower third of the forearm. ( Pre-
sented by Professor H. Gayer.)

100. The anterior half of the ungual phalanx of the middle finger
necrosed and exfoliated in connection with a “ whitlow.” ( Pre-
sented by Professor H. C. Cutcliffe, f.k.c.s., &c.)

101. “ Macerated bones of the lower half of the right forearm and
hand, with osseous spicula entering into the composition of a
tumour, which involved the whole of the hand.” (Ewart.)

102. Caries of the right acetabulum, with thickening of portions of
the brim by the irregular deposit of new osseous tissues. No
history.

103. “ Left femur bent from rickets, the convexity pointing ante-
riorly.” (Ewart.) The bulbous enlargement of the condyles
below, and of the head of the bone and trochanter major above,
is also very t}Tpically represented.

104. Rickets affecting the right femur. The ends of the bones are
enlarged. The shaft foreshortened, curved anteriorly, flattened
laterally.

105. Left femur bent from rickets. The bone has been divided
longiiudinally in order to exhibit the highly porous, wide-meshed,
exaggerated, cancellous structure of the extremities, and the
thickening of the compact tissue of the shaft.

106. The lower half of the left femur and upper two-thirds of the
corresponding tibia and fibula. — From a European girl, E.D., aged
17. Amputation of the thigh was performed for scrofulous
disorganization of the knee-joint. “The right leg was removed
a year previously for the same disease.” There had existed
several “scrofulous ulcers” around the joint “since childhood.”
The knee-joint (left) was flexed at an acute angle, and almost
ankylosed in this position. Through an unhealthy-looking ulcer,
on its inner aspect, a portion of the internal condyle of the
femur protruded as a dry blackened mass. The bones as now
preserved (dry) exhibit (I; thickening and roughening of the
shaft of the femur for three inches above the articular end; the
latter expanded; the inner condyle necrosed superficially and
throughout carious ; the external condyle also superficially carious ;
the intercondyloid notch widened. The osseous tissue of the
whole of the lower extremity of the bone is very soft and can-
cellous, in parts filled with an earthy, chalky (phosphatic) deposit.
(2) The head of the tibia shows similar changes ; the bone highly
expanded, porous, brittle, and soft. (3) There is superficial
caries of the anterior margin of the shaft for two inches below
the head of the tibia. (4) 'Similar changes have extended to the
head of the fibula. The rest of this bone is remarkably slender
and attenuated. All these bones arc very greasy,— largely
infiltrated with fat.

SERIES II.]

OF THE LOWER EXTREMITY.

107. Chronic inflammation (ostitis) of the right femur. A considerable
deposit of new bone has taken place, not only over the surface of
the bone, but also between its lamellae, and especially concentric-
ally, so as to obliterate completely the medullary canal, ihe
bone throughout is very dense, firm, and heavy.

108. Inflammation (chronic) of the shaft of the left femur, which is
greatly thickened and rough externally, and, as a longitudinal
section shows, the cancellous tissue has become so condensed and
infiltrated, as it were, by new bone that it is almost indistin-
guishable from the compact portion of the shaft. The medullary
canal, in the middle third of the bone, has been almost obliterated
by these changes. The whole bone has increased in density and
weight.

109. A similar preparation (chronic ostitis) of the left femur. The
bone is greatly increased in thickness and weight, the cancel-
lous tissue of the shaft converted into compact firm bone, and
the medullary canal completely obliterated.

110. Inflammatory hypertrophy of the right femur. A large quantity
of new bone has been thrown out all round the shaft of the bone,
which is rendered thereby rough and scaly. A longitudinal sec-
tion made through the bone also exhibits great sclerosis of the
compact tissue, so that it measures from one-half to one-third of
an inch in thickness. The medullary canal has been much
encroached upon and narrowed. The whole bone seems to have
increased in length as well as thickness (breadth).

111. Chronic ostitis of the left femur, with nodular thickening of the
bone, on its inner aspect, in two situations, viz. at the upper
third of the shaft below the lesser trochanter, and at the lower
third, just above the inner condyle. In these situations the
compact tissue is seen to be greatly expanded, and, at the same
time, exhibits interstitial absorption of the central lamella, with
the formation of a pseudo-cancellated structure. A large quan-
tity of new bone has been thrown out at the periphery of each
nodular expansion, and to a less extent generally over the
external surface of the whole shaft.

112. Chronic inflammation of the whole of the shaft of the left femur.
The external surface is greatly thickened from deposit of new
bone. The compact tissue hypertrophied ; the medullary canal
almost obliterated. On the anterior and internal aspects of the
bone, at the upper and lower thirds of the shaft, two circum-
scribed patches of caries of the cortical layer are also to be
observed,

113. Acute periostitis and ostitis of the left femur, following amputa-
tion at the lower third of the thigh, in the case of a Hindu boy
aged 6, who had met with a compound fracture of the leg ( see
series I, prep. No. 161).

About an inch and a half of the lower end of the shaft is seen
separated from the rest. This was the part first removed (with
bone forceps) when the bone had become bare, and the perios-
teum had receded from its surface in the amputation wound.
The disease progressed, however, unchecked; and, as may be seen

DISEASES OF THE BONES

[series II.

in the preparation, the whole of the periosteum investing the
shaft, as high up as the head of the bone, has spontaneously
separated, or may be readily stripped off the subjacent bone,
which is bare and dry, the periosteum itself being much swollen
and softened in consistency. The medullary canal is occupied
by soft, highly vascular, diffluent medulla (incipient osteo-
myelitis.)

The patient died from exhaustion and hyperpyrexia attending
these changes. ( 'Presented by Professor H. C. Cutcliffe,
F.R.C.S., &c.)

114. Periostitis and ostitis of the whole of the right femur,
with necrosis and exfoliation of portions of the shaft of the
bone.

The whole bone is abnormally and irregularly thickened. At about the
centre of its posterior surface is an irregular- outlined excavation,
the result of necrosis, and a larger one on the posterior and inner
aspect at the lower third of the shaft. From both these, dead
bone was discharged by means of long sinuses in the soft parts
superjacent, opening by several fistulous apertures on the
posterior and inner aspects of the thigh. In attempting to
gouge out (by operation) some of the necrosed bone from the
lower of the two cavities just described, the femoral vessels (in
Hunter’s canal) were encountered, and the femoral artery was
accidentally injured.

Secondary haemorrhage after this accident was the immediate cause of
death.

It will be noticed that the disease has extended into both the knee and
hip-joints. In the former, the encrusting cartilage over the
upper half of the condyles has been removed, and the bone is
exposed and rough. The same conditions existed in the head
of the tibia, and there was considerable soft ankylosis of the
joint. The cartilage from the posterior and inner aspect of
the head of the femur has been absorbed, leaving a red, raw,
granular condition of the exposed bone. The acetabulum was
similarly affected.

The preparation is taken from a native male, aged 22. According to his
statement the disease had existed for about five years, and the
necrosis of the bone was consequent upon a large abscess of the
thigh, which formed after a severe attack of malarial fever. The
abscess was opened, but never healed, — continued to discharge
pus, and after a time, bits of dead bone. In this condition
he was admitted into hospital. (“ Surgical Post-mortem
Records, ” vol. I, 1875, pp. 123-24). {Presented by Professor
K. McLeod, m.d.)

115. Extensive periostitis of the right femur. A longitudinal
section through the upper two-thirds of the bone showed
also a softened and incipiently suppurative condition of the
medulla. The periosteum is throughout inflamed and thick-
ened ; in parts completely detached from the subjacent osseous
surface.

SERIES II.]

OF THE LOWER EXTREMITY.

From a native male, aged 28, admitted with symptoms of acute
periostitis, following upon a large abscess in the calf of the leg.
The thigh was amputated after other remedial measures had
failed, but the patient died quite exhausted by the profuse dis-
charge from the wound, and with symptoms of septic poisoning.

116. The upper third of the right femur, showing general thickening
and condensation (sclerosis) of the bone, and roughening of the
trochanters and posterior surface of the shaft — especially along the
linea aspera — from the formation of new bone. All these changes
are the result of ostitis and periostitis, consequent upon large
burrowing abscesses in the upper part of the thigh. From
a native male (Gopal), who died in hospital while under treatment.
(“ Surgical Post-mortem Records,” vol. I, 1879, pp. 569-70.)

( Presented by Professor S. B. Partridge, r.n.c.s., &c.)

117. Left femur, exhibiting the formation of new bone in the shape of
rough projections and processes along the linea aspera, and
thickening of the upper and middle portions of the surface of
the shaft from the same cause.

These changes are the result of periostitis and ostitis, associated
with large burrowing abscesses in the thigh, following upon
small-pox.

The patient, a native male, aged 55, had suffered from a severe
attack of small-pox about three months prior to admission into
hospital. He was in a very weak and debilitated condition.
The abscesses were opened and drained, but the man died from
exhaustion and gangrene of the left lung. (See further, “ Sur-
gical Post-mortem Records,” vol. I, 1879, pp. 579-80.)

118. The upper half of the left femur, from an amputation at the
middle of the thigh, showing (1) denudation of the bone from
loss of periosteum for about two inches above the level of the
stump ; and (2) a putrid condition of the medulla (osteo-mye-
litis). On a longitudinal section being made through the bone,
the medullary canal was found filled with a dirty, yellowish-pink,
abnormally fluid medulla, the remains of which can still be seen
in the preparation. Examined microscopically, this was composed
of (a) a very large number of red blood-cells and pigmented
corpuscles, of spindle and angular shape ; (b) an abundance of
granular, nucleated pus-cells ; ( c ) a great deal of free fat in
molecules and globules — either simply opaque, or variously
tinged yellow or pink ; ( d ) round, granulaticn-like cells, with
single large nuclei, or some similarly nucleated but spindle-
shaped cells, &c., &c.

Similar material fills the cancellous structure of the trochanters and head
of the bone : the latter is abnormally soft.

The patient, a native male, aged 30, was admitted into hospital with an
improperly-treated compound fracture of the lower third of the
femur, which had existed for a month and a half, and was now
associated with burrowing sinuses in the soft parts around,
leading down to the injured bone.

There was suppurative thrombosis of the left femoral vein, multiple
abscesses in the lungs, and other evidences of pyaemia, which was the

DISEASES OF THE BONES [series ii.

cause of death after operation. (“ Surgical Post-mortem Records,”
vol. I, 1S80, pp. 663-61.)

119. Osteo-myelitis of the left femur, secondary to amputation at the
lower third of the shaft for acute traumatic synovitis, with
suppurative disorganisation of the knee-joint. A second ampu-
tation of the hip-joint had to be performed. The patient, a
Mahomedan adult, “ Haji Ismail, died ninety hours after the after
latter oporation, with symptoms of pyaemia. ” (Colles.)

A longitudinal section through the upper two-thirds of the bone shows
“ extensive purulent deposit throughout the medulla and cancel-
lous structure of the shaft, reaching even into the trochanters
and head of the hone.”

On post-mortem examination, both pleurae were found inflamed, and
multiple abscesses in the lungs. ( Presented by Professor Fayrer.)

120. Osteo-myelitis of the left femur, after amputation, at its lower

third, for scrofulous disease of the left knee-joint, in a European
girl,(E. D.), aged 17. ( See prep. 106.)

121. Upper part of the right femur showing osteo-myelitis and partial
destruction of the cancellous tissue of the bone after amputation,
at about the middle of the thigh, on account of complete
disorganisation of the knee-joint, and burrowing abscesses in its
neighbourhood. From a native boy aged 11.

The periosteum at the lower portion of the bone is completely removed,
leaving its surface bare. This portion of bone, about two inches
in length, was exposed in the stump and removed by bone-
forceps.

The medulla of the whole shaft was found very much softened, and
the innermost layers of the cancellous structure of the bone
infiltrated with purulent fluid : the disease, in fact, has only
stopped short (as may be seen in the preparation) at the carti-
laginous lines separating the epiphyses of the head and
trochanter major from the rest of the shaft.

Death took place on the seventh day after amputation. ( Presented by
Professor H. C. Cutcliffe, r.R.c.s., &c.)

122. Osteo-myelitis of the left femur. This condition was associated
with suppurative synovitis (pyaemic) of the left knee-joint in a
native woman, aged about 50. The patient received a severe
contusion of the right forearm, which was followed by local
suppuration. Burrowing abscesses formed, and the ulna became
partiklly denuded of periosteum. Fever with rigors super-
vened, the left knee-joint swelled and suppurated, and ultimately
dysentery of severe type complicated the case and hastened the
fatal issue. ( See further, “Medical Post-mortem Records,”
vol. I, 1873, pp. 209-10.)

123. A longitudinal section through the upper half of the left femur
showing extensive osteo-myelitis. The medullary canal and can-
cellous tissue of the bone, including that of the giveat trochanter,
are involved in the inflammatory process. They present (in
fresh state) a highly vascular pus-infiltrated condition.

From a case of acute suppurative synovitis of the left knee-joint in a
native female, aged 20. The thigh was amputated, at the lower

SERIES II.]

OF THE LOWER EXTREMITY.

third, on account of the diseased joint, but this condition of the
femur setting in after the operation, a secondary amputation at
the hip-joint was necessitated and performed. The patient,
however, died from pyaemia. ( Presented by Dr. Edward Lawrie.)

124. The lower half of the shaft of the right femur exhibiting super-
ficial caries of the surface, with great expansion (osteo-porosis)
of the cancellous structure in the interior. The compact tissue
is reduced to a mere shell.

125. “ Caries of the lower extremity of the left femur, with
(nodular) hypertrophy of the cortical part of the middle
third of the shaft.” (Ewart.)

126. “ Caries, with enlargement of the lower third of the right femur.”
(Ewart.) Both condyles of the bone are also involved in the
disease.

127. Extensive caries with necrosis of the condyles of the femur,
head and upper third of the shaft of the tibia, and upper third
of the fibula. There is also a large growth of new bone over
the inner and posterior aspects of the shaft and head of the
tibia. The knee-joint appears to have been perforated aud
secondarily involved. No history.

128. Extensive caries of the inferior third and condyles of the left
femur, and of the head of the tibia. A large portion of the
external condyle of the femur and the outer half of the head of
the tibia have been completely destroyed and removed.

129. Superficial caries of the external condyle of the right femur on
its outer aspect, involving a space about the size of a rupee.
No history.

130. The upper third of the left femur, exhibiting a roughened and
superficially carious condition of the great trochanter. There
were large burrowing abscesses and sinuses around the hip-joint,
which itself was not implicated.

From a native male, aged 38, who died in hospital. (See further,
“Surgical Post-mortem Records,” vol. I, 1879, pp. 597-98.)

131. Central necrosis of the upper two-thirds of the shaft of the
left femur. The dead bone is seen to be surrounded by an
exuberant growth of new osseous tissue, but large cloaca? are
left on the inner and outer aspects, through which the condition
of the sequestrum can readily be recognized. The head and
trochanters remain unaffected. There is no history of the case,
but the bone evidently belonged to a young subject, as the’
epiphyses for the head and trochanter major have not yet
completely united with the shaft.

132. Necrosed fragments removed “ from an old case of fracture of
the femur.”

133. A large sequestrum of the femur, removed after amputation of
the thigh “ for popliteal aneurism.” From a native male patient
named Abbas. The portion of dead bone is about four inches

in length, and involves the whole thickness of the shaft of the
bone.

1.34. A very interesting preparation, showing (1) the lower third of
lUe lelt femur, the condyles of which are bare, rough, destitute of

DISEASES OF THE BONES

[series ir.

periosteum, ancl almost completely necrosed. This portion of the
bone protruded from the soft parts, after a “ natural amputation”
had taken place at the knee-joint, i.e. after gangrene and
spontaneous separation of the entire leg. (2) Above the con-
dyles, the shaft, for about three inches, is seen covered by
thickened and granulating soft parts (muscles, fibrous tissue,
&c.). This had a healthy appearance, and the line of demarcation
between it and the dead comtyles was most distinct, and can be
well seen also in the preparation. (3) Above this part is
suspended a sequestrum of the whole thickness of the shaft of
the bone, involving about its middle third. This sequestrum
was enclosed Avithin a shell of newly-formed bone, and was
removed when amputation was performed a little below the
middle third of the thigh.

The patient, a native male, aged 32, stated, on admission into hospital,
that about five months ago he, while in a state of intoxication,
fell oil' the roof of a two-storied house and sustained a com-
pound fracture of the left ankle. The fracture was treated by a
native doctor, but the wound sloughed, the sloughing extended
to the whole foot, and it (the foot) at last separated from the leg
by natural processes (amputation). The morbid action, how-
ever, did not stop short of this, for, according to him, the leg
then became gangrenous, the soft parts gradually disorganising
and separating, and at last the entire leg dropped off at the knee-
joint. There lias beer, since then a tendency to ayet further exten-
sion of the sloughing process up the thigh. The condyles of the
femur had become uncovered and necrosed, but a healthy line of
demarcation now (on admission) seems to exist a little above
them ; and in this state, with the bare and rough and blackened
condyles protruding from a granulating fleshy stump, he sought
relief at the hospital.

After amputation {secundum artem ), as above mentioned, the man
made a good recovery.

135. Complete necrosis of the shaft of the left femur. From a
native bojq aged 9 years, \\dio died in hospital. From the lower
epiphysis to the great trochanter the bone is bare, of a dead-
Avhite colour, and surrounded by a soft shell of porous, spong}',
imperfectly-formed osseous tissue, which is only incomplete
on the outer aspect. The lower epiphysial and diaphysial
surfaces are rough and partially necrosed. The disease appears
to have commenced here, and affected the shaft secondarily.
The inferior surface of the patella and the inter-condyloid
notch of the femur are rough and superficially carious, and
this is also the condition of the outer articulating surface on
the head of the tibia.

136, Bisection of a portion of the shaft of the femur in a thigh
amputation (for gunshot-injury), on the forty-fifth day, OAving to
necrosis of the stump, &c. From a native male, aged 23.
The resected portion* is a piece of the femur, about one inch
in length, Avith an exuberant rampart of partially hard, partially
soft, tissue around it. The bone is dry and bare — quite necrotic.

SERIES II.]

OF THE LOWER EXTREMITY.

The basal portion of the growth around it is hard and bony,
i.e. new bone thrown out over the necrosed stump ; the super-
ficial portion is softer and, fibrous-looking, and, under the
microscope, is seen to consist of firm, connective (fibrous) tissue,
is a state of active proliferation, — numerous round and spindle-
shaped cells and small blood-vessels permeating the structure
in every direction. It is evidently the periosteum itself under-
going inflammatory changes.

137. Bilateral exostosis of the femur. Each growth is about the
size of a walnut, very irregular in outline, somewhat contracted
at its base of attachment to the shaft, and the surface rough and
tuberculated.

138. The upper half of the shaft of the left femur showing a bony
growth (osteophyte), situated a little below and behind the lesser
trochanter, on the posterior aspect of the shaft. The head of
the bone is also rough and carious, and the hip-joint was found
disorganised. The osseous growth is dendritic in configuration,
is seen to spring from the upper two inches of the linea
aspera, and is composed, evidently, of newly-formed osseous
tissue. It is deeply grooved on the inner side, and throughout
perforated by larger and smaller openings or fenestrae. There is
a little new bone also thrown out along the anterior inter-
trochanteric line. ( See further, “ Surgical Post-mortem Records,”
vol. 1, 1879, pp. 555-5G.)

139. A bony tumour removed from the inner side of the left femur.
From a native male (Nobin), aged 25. The growth is stated
to have been of fifteen years’ duration, and to have originated
from an injury,— a blow with a hammer, — on the inner side of the
thigh. This is an osseous outgrowth, not a true tumour.
It has a broad base where chiselled off from the femur ; beyond
this becomes somewhat contracted, but expands again a little,
and has a square-shaped, truncated extremity, which is deeply
fissured, and so forms seven or eight irregular-sized flattened
tubers. These are all tipped with cartilage, and invested by
a perichondrium continuous with the periosteum of the remain-
der of the growth. The bulk of the latter consists of cancel-
lous osseous tissue, with only, here and there, small portions
firmer and more compact-looking.

140. An enormous enkephaloid tumour of the lower end of the right
femur. — From a native female, aged 40.

The knee-joint is also involved, and measured at the widest part
21 inches.

The lower extremity of the femur is seen to be almost completely
disorganised ; the condyles enormously expanded. The shaft
of the bone is necrosed, destitute of periosteum at its lower end,
and the medulla soft, fatty, and vascular throughout. The head
of the tibia and the upper portion of its shaft ( vide preparation)
are very soft and highly fatty. The inter-articular cartilage
has become transformed into a glistening, soft, gelatinoid mass,
coloured pink and red. All the ligaments and soft structures
entering into the composition of the knee-joint have undergone

DISEASES OF THE BONES

[series II.

disintegration, their remains being indicated bj soft, shreddy
and pulpy fragments, hanging loosely within and about the
joint.

Scrapings and sections from different parts of the growth exhibit
(under the microscope) a large number of polymorphous cells,
the majority largely charged with fat granules and molecules,
and some with (apparently) colloid material. The more
perfect cells have large single or double nuclei, &c. The stroma
is scanty, but fibrillated. The appearances indicate beyond
reasonable doubt that the growth is enkephaloid carcinoma, —
a magnificent example of primary cancer of bone. The disease
seems to have commenced in the cancellous or medullary
tissue of the lower end of the femur. The condyles have
subsequently expanded, then the knee-joint became impli-
cated, the ligaments, inter-articular cartilage, synovial membrane,
and patella, &c., all being gradually involved in the widespread
infiltration of the growth.

The patient stated that the tumour was of a little more than two years’
growth, commencing as a small swelling below the right patella,
and attended with pain, at first only on movement. It has
gradually attained its present formidable size (that of a water-
melon), increasing very rapidly during the last three and a half
months. It occupies the whole circumference of the right thigh,
being, however, more prominent anteriorly than posteriorly ;
is soft to the feel, painful on pressure ; the skin over it oedema-
tous, and covered by a network of large superficial veins. A chain
of indurated lymphatic glands could be felt along the course of
the femoral vessels up to the groin, and even beyond, into the
abdomen. During her stay in hospital the patient accidentally
fell off her bed and sustained a simple facture of the femur at
about the middle third, or just above the tumour. This injury
was succeeded in a few days by paralysis, first of the lower, and
then of the upper extremities. She remained in a semi-conscious
state for two days, then gradually became low and comatose, and
thus died. ( See further, “Surgical Post-mortem Records,”
vol. I, 1873, p. 22.)

141. Extreme atrophy of the right fibula. “ The whole of the earthy
matter of the shaft has disappeared, and at the extremities of
the bone some has been absorbed and replaced by fat. The
shaft is now represented by a mere string of fibrous tissue.”
(Ewart.) No history.

142. “ Right tibia, bent from rickets.” The bone presents a prominent
anterior curvature at its lower third, is flattened from side to side
in the upper two-thirds, and shows bulbous expansions of the
superior and inferior extremities.

143. “ Tibia, bent and thickened from rickets. There is a good deal
of chalky infiltration of the cancellous structure and medullary
lamina of the shaft.” (Ewart.)

144. Rachitic enlargement of the superior and inferior extremities
of the bones of both legs. This is especially well marked in the
tibiae. There is also considerable obliquity of the articulating

SERIES II.]

OF THE LOWER EXTREMITY.

surfaces at the knee-joint ; the head of each tibia is twisted
so as to form an obtuse angle with the shafc, and the articular
surface for the inner condyle of the femur lies on a plane at least
two inches below that for the external condyle. The knee-joints
were thus displaced outwards {genu varum), and the legs bent
inwards towards the ankles. There is a kind of compensatory
obliquity of the expanded lower extremities of the tibiae, they
being directed downwards and outwards, while the superior
extremities look upwards and inwards.

The superior and inferior extremities of the fibulae show similar, but
less marked, changes : the condyles of the femur do not appear
to be materially altered either in structure or position.

The subject was a native male (Hindu), aged about 24-, who died in
hospital from dysentery, with multiple abscesses of the liver, <fec.
(“Medical Post-mortem Records,” vol. Ill, 1830, pp. 587-88.)

145. A Ion gitudinal section of the right tibia showing nodular thick-
ening of the compact tissue of the shaft, at the upper and middle
thirds of the bone, the result of syphilitic ostitis.

146. Diffuse inflammation (ostitis and periostitis) of the shafts and
lower extremities of the left tibia and fibula, resulting in con-
siderable thickening and roughening of their external surfaces,
from an exuberant deposit of new osseous tissue, and the union
or ankylosis of both bones at their lower thirds.

147. Inflammation (ostitis, &c.) of the lower half of the right tibia
and fibula, with great thickening of the surfaces of these bones
by a deposit of new osseous tissue. The inferior tibio-fibular
articulation is thus ankylosed, and many bridges or spicules of
new bone exist between the opposed margins of the lower three
inches of these two bones. Portions of both malleoli are
necrosed ; the ankle-joint perforated ; the articular osseous
surfaces extensively carious.

148. Chronic inflammation of the whole of the shaft of the right tibia,
resulting in great thickening of the surface and compact tissue
by formation of new bone. As seen in the section made through
the tibia, the compact tissue appears to have undergone expan-
sion, and then consolidation, especially towards the central
portion of the shaft. At the same time, the cancellous tissue
has also become more condensed, and the medullary canal com-
pletely obliterated. There is, further, superficial caries of the
new bone at^the surface of the shaft and towards the articular

1 ,Q ^ -remities. The knee-joint appears to have been implicated.

...ensilf syphilitic ostitis and periostitis of the shafts of both
tibiae. From a European patient (male), aged 3G, who died
m hospital. On the anterior aspect (shin) of the right tibia,
about midway between the upper and lower extremities, is a
circular, crater-like opening, the size of a four-anna piece It
leads into a small cavity, at the bottom and sides of which

i necrosed- APat>t this excavation, the whole
oi the shaft of the tibia is seen to be abnormally thickened
iicl presents a broadly nodular condition along the whole of
tne anterior surface. The periosteum can be stripped awaj

DISEASES OF THE BONES

[8EBIES II.

easily, and dead and rough bone is found beneath it. Somewhat
similar nodular thickening of the shaft of the left fibula is also
clearly manifested. At the junction of the lower with the
middle third of the light tibia, an ununited transverse fracture
of the shaft is found, the fragments being held together by
greatly thickened periosteum ; and, at the middle of the left
tibia, there is a similar oblique fracture, directed from in front
backwards and outwards through the whole thickness of the shaft.
The ends of the bones here are also only connected by fibrous
tissue ; there is no bony union. These fractures had occurred
subsequent to the existence of chronic inflammatory changes in
the bones; that of the’ right leg from a fall from a horse about
a year prior to admission into hospital ; that of the left tibia from
an accidental “ twisting ” of the leg six months later on.

The absence of bony union is attributable to the constitutional dys-
crasia (syphilitic) of the patient, which was most marked. (See
further, “ Surgical Post-mortem Records,” vol. I, 1877, pp.
371-72.)

150. “Stump of leg amputated below knee, showing osteo -myelitis
of the tibia, with the characteristic fungus-like protrusion of
the medulla from the cut end of the bone (seen also to a much
less extent in the fibula), and a flabby, sloughy condition of the
flaps.

From a Mussulman, admitted writh moist gangrene of the left leg and
foot. He died from pyaemia thirteen days after the amputation,
and twenty days after the receipt of a wound on the heel, which
was the exciting cause of the gangrene.” (Colies.) (. Presented by
Professor J. Fayrer, m.d., &c.)

151. Inflammation of the lower half of the right tibia, and, to a less
extent, of the corresponding portion of the shaft of the fibula,
with superficial caries and necrosis. On a longitudinal section
being made, a circumscribed abscess in the cancellous tissue
of the lower end of the tibia was discovered, and its cavity may
be seen in the preparation. It is about the size of a pigeon’s
egg, and situated about two and a half inches above the ankle-
joint, which is not implicated. ( Presented by Professor Allan
Webb.)

152. “ Caries of a portion of the shaft of the tibia.” (Ewart.) No
history.

153. Caries of the left tibia, affecting, chiefly the external compact
tissue of the shaft, and the upper and lower extremities. The thick-
ness and weight of the whole bone are at the same time greatly
increased, owing to inflammatory changes. No history.

154. Caries of the whole of the shaft of the left tibia, the central
portion of which has been completely destroyed. The fibula is
thickened by an irregular deposit all over its surface, and there
is bony union or ankylosis of the superior tibio-fibular articu-
lation and adjacent osseous surfaces of both bones.

155. “ Caries of the (left) tibia, destruction of the middle third of the
shaft, and ankylosis of the middle third of the tibia and fibula
by the production of new bone between them.” (Ewart.)

SERIES

156.

157.

158.

159.

160.

.161.

162.

•163.

164.

n.]

OF THE LOWER EXT H EMIT Y.

" Caries of a large portion of the shaft of the tibia.” The fibula
is thickened by deposit of new bone.

“ Caries and necrosis of the middle third of the right tibia.” A
portion of the anterior margin (shin) has exfoliated ; another
portion, a little lower down, is surrounded by a distinct groove
of ulceration, is dead, and ready to be exfoliated. There is
superficial caries also of the posterior surface of the shaft and of
the head of the tibia.

“ Caries of the upper and lower extremities of the left tibia.”
Both knee and ankle-joints appear to have been involved in the
disease. The compact tissue of the central portion of the shaft
exhibits nodular thickening, with great narrowing of the medullary
canal for about three inches. No history.

“ Caries of the lower extremities and articular surfaces of the left
tibia and fibula.” (Ewart.) A portion of the cancellous tissue of
the former has apparently necrosed, leaving an excavation, the
size of half a walnut, on the anterior aspect of the inferior
extremity.

Great expansion and inflammatory thickening of the inferior
extremities of the left tibia and fibula, with apparently super-
ficial necrosis of the newly-formed osseous tissue, extending
upwards as far as the middle of the shafts of these bones. The
inferior tibio-fibular articulation is firmly ankylosed, and the
fibula, about three inches above the point of the malleolus,
exhibits rounded callus-like thickening and distortion, as if an
old fracture had taken place at this spot. The articular ends of
both bones are also superficially carious. No history.

Caries and necrosis of the lower half of the shafts of the left tibia
and fibula, and of the bones of the tarsus, metatarsus, and
p alanges. There is also bony ankylosis of the inferior tibio-
fibular articulation of the ankle-joint, and of all the tarsal and
metatarsal articulations. Large stalactitic processes of new bone
ia\e been thrown out behind the ankle, springing chiefly from
the upper and posterior margins of the os calcis.

The right and left tibise showing nodular thickening, with
superficial caries of the upper third of their shafts, particularly
ot the inner subcutaneous surfaces. In the right tibia there
is, in ac < ltion, an adventitious growth of new bone (hyperostosis)
a e ow u timd of the shaft, affecting the inner surface down
to the malleolus, and extending backwards to the posterior
sur ace. hese conditions are all due to chronic syphilitic
ostitis.— From an East Indian male, aged 25.

Necrosis of the lower two-thirds of the left tibia, with an

th ,?e G ^attemPt ft substitution of the same by new bone
tnioun out around the dead shaft. J

tfeZ°hn th? Hght fibu!a- AImost the whole of the shaft
At this 116 has been involYed> hut the lower third in particular.

can be -hr foi™atlon of new hone is also abundant, and

can be seen encircling the sequestrum.

DISEASES OF THE BONES

165.

166.

167.

168.

169.

170.

171.

172.

173.

174.

[series II.

Necrosis of the right tibia. A large portion of the inner
surface of the shaft has exfoliated. The dead bone was removed
in pieces during life, and these have now been replaced in situ.
Central necrosis of the shaft of the left fibula ; the sequestrum
remains invaginated. The external surface of the shaft is rough
and thickened from an irregular deposit of new bone.

Central necrosis of the entire shaft of the right tibia, from the
upper to the lower epiphysis. “ The dead bone is enclosed
posteriorly and laterally by new bone, which is continuous with
the head and inferior extremity of the tibia, but is open in
front. It is quite loose, but so incarcerated that it cannot be
dislodged through any of the openings. A good deal of new
osseous structure is thrown out around the fibula, which, at the
lower three or four inches, is ankylosed to the tibia.” (Ewart.)

( Presented by Dr. Rose, of Penang.)

Necrosis of the right tibia. At the upper third of the anterior
aspect of the shaft a large excavation in the bone is observed,
three inches in length, one and five-eighths of an inch in breadth,
and nearly half an inch deep, with thickened, rounded edges formed
by newly-organised osseous tissue. The central portion of the
shaft presents considerable nodular thickening from the same
cause. The cancellous tissue of the head has been extensively
destroyed, and the knee joint perforated. ( Presented by Professor
Harrison.)

“ Portion of the left tibia of a Chinaman, showing a cavity,
from necrosis, underneath an old ulcer.” (Ewart.) The cavity
is the size of a pigeon’s egg, has sharp and abrupt margins, and
is situated at the upper third of the internal surface of the
shaft.

“ Specimen showing necrosis of the inferior third of the (left)
tibia and fibula, accompanied by gangrene of the soft parts,
supervening upon an attack of malarious fever. The limb was
amputated at the junction of the superior with the middle third
of the leg. There was no bleeding, owing to plugging-up of
the large blood-vessels. Small portions of the tibia and
fibula exfoliated, but the patient made an excellent recovery.”
(Ewart.)

“ A necrosed portion of the tibia of a native, aged 14 years,
who had been suffering upwards of five months.” (Ewart.)
The dead portion of bone is eight inches in length ; its upper
three-fourths consist of the whole thickness of the shaft, its
lower fourth of the exfoliated outer layer only.

Necrosis of the whole thickness of the middle third of the
fibula. Removed after death from a native male “who under-
went Syme’s operation for cancer of the foot.” ( Presented by
Professor J. Fayrer, m.d., &e.)

“ A portion of necrosed tibia which exfoliated, reparation having
been affected by granulation.” (Ewart.) (Presented by Pro-
fessor R. O’Shaughnessy.)

Four large exfoliations of the outer or compact layer of a
necrosed tibia. ( Presented by Mr. C. E. Haddock.)

SKBIES II.]

OF THE LOWER EXTREMITY.

175. “Exfoliated lamina of bone removed from the right tibia.”
(Ewart.) ( Presented by Professor S. 13. Partridge, f.r.c.s., &c.)

176. A portion of the necrosed shaft of the fibula, about two and a
half inches in length, including the whole thickness of the bone.

177. Complete necrosis of almost the whole of the shaft of the tibia,
“ from a Christian boy, aged three years.” The disease is
recorded to have “ followed after an attack of fever.

178. Necrosed right tibia from a native male, aged 45, “ an opium-
eater and a drunkard.” “The disease was of eight years’
duration, but had from time to time been in abeyance. He was
emaciated and anaemic to a degree. Several pieces of bone had
come away. Six months ago he received a severe injury, — a
piece of stick having penetrated the limb, — and this brought
back the disease with renewed energy. There were several
severe haemon-hages from the surface.” Amputation below the
knee was performed successfully. “ After the operation the
man gained flesh, and was discharged cured.” ( Note by tiuryeon^
Major E, A. Birch , f.r.c.s., by whom the preparation was
presented .)

At the middle third of the bone there is a deep gap on the inner aspect,
produced by caries and necrosis combined. It reaches almost
completely through the shaft. On the outer and posterior
aspects, in the same situation, the surface is roughened and
tuberous from considerable deposit of new bone. Similar
thickening extends downwards to the lower third of the shaft.

179. The upper half of the right fibula completely necrosed, and
exhibiting, about an inch below the head, a curious ring-like
expansion of the shaft, which is perforated. The opening -would
admit a small walnut. Below this, the shaft is greatly narrowed
and constricted, reduced to a thickness of only about one-fourth
of an inch. The patient is said to have suffered from “ madura-
foot disease.” (Presented by Surgeon J. II- Newman, Political
Agency, Jodhpore.)

180. Portions of necrosed tibia and fibula, which exfoliated in the stump
of an amputation of the left leg for gangrene. ( See prep. 170.)

181. Exfoliation in three pieces of the end of the tibia in a stump
at the lower third of the right leg, amputation having been
performed at this spot for elephantiasis of the foot and caries
of the tarsus, in a native male patient at Dacca. “ The man
made a good recovery.” (Presented by Dr. W. B. Beatson.)

182. “ Secondary amputation of the right lower extremity below
the knee, performed on account of the large extent of the skin of
the stump sloughed off after the primary amputation, exposing
the ends of the tibia and fibula, portions of which are quite
destitute of periosteum. The soft parts are undergoing repair
by granulation, and from the cut surface of themedullary part of
the tibia granulations are visible.” (Ewart.)

183 “ Longitudinal sections of two metatarsal bones, removed

from a native male, about 25 years of age, whose correspond-
ing toes had dropped off from dry gangrene, and of another
metatarsal, and the attached phalangeal bones of the same foot

DISEASES OF THE BONES

[series ir.

illustrating extensive fatty degeneration, induced by imperfect
nutrition, consequent on arteritis and complete blocking-up of
the principal vessels by fibrin. The cancellated structure is
almost wholly occupied by fat. The cortical layer of the bone
is much attenuated. So soft were these bones that the sections
now presented to view were as easily made with a scalpel as if
they had been made through a piece of cheese. On microscopical
examination a large quantity of fat globules was found. The soft
part of the Haversian systems were almost completely replaced by
this fat.” * * * * * After amputation of the foot, “ no

ligatures were required, and no sutures were employed.” (Ewart.)
( Presented by Professor Sir J. Fayrer m.d., &c.)

184. “ Part of the first phalanx of the great toe of a woman aged
50, with fragments sliced away from the head of the first
metatarsal bone, displaying an immense deposition of yellow-
coloured fat, occupying the soft parts of the cancellated struc-
ture. The cortical portion of the bones has been almost
completely destroyed by fatty degeneration. The sections
now presented were made with the scalpel as easily as if the
bone had been replaced by cartilage.” (Ewart.)

185. Extensive caries of all the bones of the left tarsus, — the astra-
galus in particular. This bone is quite soft and spongy, its
posterior half necrosed. Two rounded sequestra were found
loosely imbedded in a cup-like cavity formed by carious bone on
its upper surface. The same surface of the os calcis is greatly
diseased, as also are the cuneiform bones ; and the carious process
has extended to the articular surfaces of the tibia and fibula,
which were removed at the time of the operation (Syme’s
amputation), and are preserved with the foot.

186. Superficial caries of the os calcis, astragalus, articulating extremi-
ties of the tibia and fibula, and of the scaphoid. The cuboid and
remaining bones of the tarsus are not affected. The astragalus
is the bone most diseased, and its general porosity and fragility
well displayed. The ankle-joint was completely destroyed.
The ligaments and synovial membrane were swollen, softened,
and shreddy ; the articulating surfaces denuded of cartilage.
Similar changes were observed in the inferior tibio-fibular and
calcaneo-astragaloid articulations. From a native male, aged 30.

187. Caries of the right foot. The preparation shows extensive
caries and osteo-porosis of all the bones of the tarsus. The
cuboid is most affected, the three cuneiform and scaphoid less
so. The astragalus is also very soft, spongy, and brittle ; a
deep line of ulceration extends round the head of the bone so as
almost to isolate it. Some new bone has been thrown out from
the anterior aspect of the os calcis, and overlaps its articulation
with the cuboid. The articular surfaces of the tibia and
fibula are rough and eroded, and the ends of these bones very
rarefied and spongy. The ends of the metatarsal bones, —
especially their tarsal extremities, — show evidences of carious
change and inflammatory thickening. The epiphysis of the
os calcis is superficially eroded, but the epiphyses of the metatarsal

8BBIEI II.]

OF THE LOWER EXTREMITY.

bones and phalanges are remarkably exempt from disease. From
an East Indian girl, aged 12. The foot was removed by Syme’s
amputation. (Presented by Dr. E. Lawrie.)

188. Caries of the right loot, of about two years’ duration. From a
native male, aged 29. The bones that are affected are the
os calcis, astragalus, cuboid, and scaphoid. The os calcis is carious
all round the margin of its superior or articulating surface, and
firm osseous ankylosis has taken place between it and the
astragalus at the internal and external margins, especially
well marked over the sustentaculum tali. The whole of the
upper, inner, and outer surfaces of the astragalus are carious.
Posteriorly, new bone has been thrown out so as to prolong this
margin of the bone backwards in a series of sharp spicula.
Anteriorly, the upper surface of the head of the bone is seen
hollowed into a cavity the size of a sparrow’s egg. The whole
bone is very light and spongy. The superior and outer margins
of the scaphoid, and the adjoining outer margin of the cuboid,
are the only portions of these bones similarly affected (rough
and carious). All the other bones of the tarsus and metatarsus
were found healthy. The foot was removed by Syme’s ampu-

* tation at the ankle-joint.

189. “ Os calcis (left) excised for necrosis. There is an opening on
the outer surface of the bone leading to a cavity, in which a large
sequestrum lies loose. The bone around this cavity is abnor-
mally dense, as shown by the section.” (Colles.) ( Presented bu
Dr. David B. Smith.)

190. “ Terminal phalanx of the great toe, removed on account of
syphilitic onychia.” (Ewart.) The bone seems to be completely
necrosed.

191. Great inflammatory thickening (hypertrophy) of the upper and
lower jaws of a horse. The osseous tissue, especially of the
lower maxilla, is greatly condensed and sclerosed, as is well seen
in the sections which have been made into the bone on the
right side. There is also superficial caries of both jaws, affecting
here and there, irregularly, the compact tissue.

1192. “ A large sequestrum from the head of an elephant. The poly,

gonal arrangement of the capacious frontal cells of this animal
is well illustrated.” (Ewart.)

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

JPA-RT XX.

DISEASES OF THE JOINTS.
DISEASES OF THE MUSCLES, &c.
DISEASES OF THE SPINE.

Series III, IV, and V.

SERIES III ]

DISEASES OB' THE JOINTS.

Series III.

DISEASES OE THE JOINTS.

INDEX TO THE SERIES.

A.— ANATOMICAL : showing the joint affected.

(a) Sterno-clavicular, 1.

(i) Shoulder, 2, 3.

(d) Wrist and carpus, 14, 15, 16.

(e) Phalangeal, 14.

(f) Hip, 17, 18, 19, 20, $1, 22. 23.

( n ) Knee, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38,
39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52.

( h ) Ankle, 53, 54.

(i) Tarsus, 55, 56.

13. — SU11GICAL AND PATHOLOGICAL : showing the nature of the

DISEASE, SURGICAL COMPLICATIONS, &C.

1. — Synovial membrane —

Inflammation of (acute), 1, 24, 37, 38, 39, 41, 42, 43, 45.

of (chronic), 25, 26, 27, 29, 30, 33, 34, 40, 44, 46, 47.

43, 49.

Excrescences or warty growths of, 28, 40, 44.

2. — Ligaments —

Softening and ulceration of, 2, 17, 24, 25, 26, 27, 32, 33, 34, 39, 41.
43, 45.

3. — Cartilage —

Absorption or ulceration of, 2, 4, 17, 19,24,25, 26, 27, 28, 29, 30,
31, 32, 33, 34, 3b, 3/, 38, 41, 43, 44, 45, 46, 47, 48, 49.

4. — Articular surfaces of bone —

Caries of, 2, 4, 5, 17, 18, 20, 28, 30, 36, 43, 47, 56.

Necrosis of, 5, 18, 32. 33, 45, 49.

5. — Scrofulous disease, 3, 19, 20, 33, 34, 47, 56.

6. — Rheumatic disease, lft, 21, 42.*

7. — Pyaemia, 1, 41, 52.

* Gouorrhueal rheumatism.

DISEASES OF THE JOINTS.

[SERIES III.

8. — Injuries or wounds of joints, 7, 8, 9, 10, 35, 37, 38.

9. — Dislocation from disease, 51.

10. — Abscesses communicating with joints, 24 (?), 29, 35, 37, 38, 39, 45,

47, 48, 49.

11. — Repair after ulceration of cartilage, 31.

12. — Ankylosis —

Soft, 13, 34, 46.

Bony, 6, 8, 9, 11, 14, 22, 23, 47, 48, 49, 50.

13. — Excision or resection of joints, 4, 5, 6, 7, 8, 9, 10* 12, 13, 19, 20.

14. — Amputation in injuries or diseases of the joints, 16, 35, 37, 38,

43, 49, 53, 54, 55, 56.

15. — Repair after amputation at ankle-joint, 54.

16. — Gunshot injuries to joints, 12, 13, 16, 52.

DISEASES OF THE JOINTS.

1. Preparation showing the right sterno-clavicular articulation laid

open. In the fresh state, the synovial membrane and ligaments
were found swollen, softened, and abnormally vascular. The
cartilage at the sternal end is thinned and eroded, exposing
hare hone over a space the size of a split pea. The joint was
occupied by about half an ounce of thick yellow pus. — From
a case of pyamiia-^-a native female, aged GO. (See further,
“ Medical Post-mortem Records,” vol. Ill, 3879, pp. 893-94.)

2. Chronic inflammation of the right shoulder-joint. The capsule

has been partially destroyed. The cancellous tissue of the head
of the scapula, including the glenoid cavity, is broken down
and carious ; the encrusting cartilage of the latter has been
absorbed from its inner half. The head of the humerus is not
affected. No history. (Presented by Professor R. O’Shaughnessy.)

3. “ Preparation showing peeling-off of the articular cartilage from

strumous disease of the cancellated structure of head of the
left humerus. The patient, aged 31, a Dane, was admitted
into hospital on the 6th December 18G2, suffering from pain
in the left shoulder-joint. He had first felt symptoms of
mischief three months before his admission, but had never
intermitted his work as an able seaman. The pain of late
had considerably increased. His general health appeared good.
He was treated with tonics and counter-irritation, the limb
being kept in a state of perfect repose. For some time he
appeared to improve, but about the end of February 18G3
symptoms of phthisis supervened, and he sank under the
disease on the 15th May. The lungs were infiltrated with
tubercle. All the other viscera were healthy.” (Ewart.)
( Presented by Professor S. B. Partridge, f.b.c.s., &c.)

* Sub-periosteal.

SERIES III.]

DISEASES OF THE JOINTS.

4 The articular ends of the right humerus, and of the radius and
ulna, excised for disease of the elbow-joint.— From a native
female (Rominni). The articular cartilage is seen to have
undergone much thinning and extensive absorption, and, where
the bone is thus exposed, it is rough and carious. {Presented by
Professor J. Fayrer, ai.d., &c.)

5. Excision of the bones of the right elbow-joint. The articular

surfaces are extensively carious ; the outer condyle of the
humerus necrosed, — hollowed out into a cavity the size ot a
hazel-nut.

6. Excision of the right elbow-joint for disease. Partial bony ankylosis

existed between the head of the radius and outer condyle ol
the humerus, and between the coronoid process of the ulna
and margin of the trochlear surface of the humerus.

7. Resection of the right elbow-joint on account of fracture followed

by ankylosis — mostly bony and immovable.

Case of Karri Shaba, a native of the Pubna district, aged 35.

When bathing six months ago, the river bank fell in upon him, and he
sustained a fracture with dislocation of both elbow-joints, which,
on admission, were found completely ankylosed in the extended
position. The right elbow-joint was excised. The injury here
appears to have been fracture of the olecranon, and probably also
of the tip of the coronoid process of the ulna, with displacement
backwards of this bone. A portion of the head of the radius (its
outer third) seems also to have been crushed. The lower end of
the humerus presents a roughened surface posteriorly, and to a
less extent anteriorly, from the presence of newly developed bone,
a portion of which tills in the olecranon fossa at the back of
the trochlear surface, and projects slightly through the thin
septum separating the olecranon and coronoid fossae, which sep-
tum appears to have been absorbed, or was (as is sometimes the
case) originally wanting. The excised portions of bone consist of
about two inches of the lower end of the humerus, the head of
the radius, and about an inch of the upper extremity of the ulna.
{Presented by Professor H. C. Cutcliffe, F.R.c.s., &c.)

8. Resection of the right elbow-joint in consequence of firm bony

ankylosis, associated with an old transverse fracture of the
humerus through the condyle. {Presented by Professor H. C.
Cutcliffe, f.b.c.s., &c.)

9. Bony ankylosis of the right elbow-joint, the result of an old injury.

The forearm was immovably fixed at a right angle to the arm.
Resection was successfully performed. The preparation exhibits
the parts removed by the operation.

10. The right elbow-joint (lower end of the humerus and upper ends of
the radius and ulna), removed by sub-periosteal resection from a
native male, aged 18, on account of rigid and chiefly bony anky-
losis ; the result, apparentljr, of an old injury to the articular ends
of the bone. {Presented by Professor IT. C. Cutcliffe, f.k.c.s., &c.)

11. Complete bony ankylosis of the left elbow-joint. The radius is

twisted forwards and inwards, and lies on a plane anterior to the
ulna. No history.

86 DISEASES OF THE JOINTS. [sebies hi. •

12. Gunshot injury to the right elhow-joint.— From Saifoo, a Mahom-

edan, aged about 40. While the hones of the forearm are
uninjured, the articular extremity of the humerus is extensively
comminuted. “The largest fragment, constituting the chief
part of the articular end of the bone, was completely detached,
and driven down partly behind the joint and partly "internal to
the olecranon.” The two other (lateral) portions of the humerus
(seen in the preparation) were sawn off at the time of the
operation, as also the articular ends of the radius and ulna,
although uninjured. Resection was performed on the day fol-
lowing the accident, and the patient made a good recovery. (See
further, “Indian Annals of Medical Science,” vol. XXXIV, p. 452.)
(Presented by Dr. E. A. Birch, Civil Surgeon, Hazaribagli.)

13. A preparation showing the results of excision of the elbow-joint

for gunshot injury. The operation was performed by Dr.
T. E. Charles at the siege of Delhi in 1857. The patient, a
European, died in the General Hospital, Calcutta, from hepatic
abscess in July 1808, i.e. 11 years after. “He had sufficient
motion left to enable him to bend the elbow to carry the hand to
the mouth Avith facility.”

An examination of the joint sIioavs that firm fibrous union has taken
place between the remains of external condyle of the humerus
(the only portion, apparently, of that bone removed) and the
base of the olecranon process of the ulna, the process itself
having been excised ; also between the internal condyle and the
same portion of the ulna posteriorly, and, Avith its coronoid process
(which still exists) anteriorly. The head of the radius is wanting.
The shaft of this bone beloAV the excised head is smooth and
rounded, and is fixed to the outer side of the ulnar shaft by
ligamentous tissue, which still permits of limited supination and
pronation. In the elbow-joint itself the movements are very
free. Possible flexion, as might be expected, is excessive ;
extension, more limited.

14. “ Carpal and metacarpal bones of a Hindu Faquir. There is

ankylosis of the metacarpal bones of the fore and middle fingers
to the trapezoid and os magnum, and of the first and second
phalanges of the same fingers to each other.” (EAvart.)

The ankylosis in this case is probably attributable to long disuse, as a
not infrequent mode of penance among this class of people is to
hold up the arm for an indefinite period, until the whole extre-
mity becomes withered and atrophic ; possibly ankylosis some-
times takes place during this process.

15. A preparation slioAving almost symmetrical deformity of the

carpal extremities of the radius and ulna of both sides,
caused by the projection of short irregular bony ridges or
prominences of newly-formed bone, especially in connection
with the grooves for the flexor and extensor tendons, and
particularly of the latter. Both radii are also tAvisted somewhat
backwards and inAvards, while the ulna? have a slight inward
curvature. These changes appear to be due to chronic rheumatic
arthritis, but there is no history of this affection on record, as

SERIES III.]

DISEASES OF THE JOINTS.

no enquiry was made during life, although the deformity was
noticed and was very distinctly visible.

The subject was an aged East Indian (male), who died from chronic
dysentery. (“Medical Post-mortem Records,” Vol. II, 1878,
pp. 989-90.)

16 Preparation from a case of gunshot injury of the right hand.
The patient, a European, H. G., of Kyouk Pliyoo (Burmah),
received a pistol-shot through the right wrist. As the wound
refused to heal entirely, and such cicatrices as had formed in
connection with it frequently ulcerated, rendering the hand
useless, amputation through the forearm was performed.

The charge, composed of small shot, was received in the palm of the
hand. Several pellets were removed from time to time, being
found encysted in the tissues bordering upon the wound.

The preparation now shows a deep carious cavity, into which the
tip of the finger may be inserted, situated in the carpus,
immediately above the second and third carpo-metacarpal
articulations. In this cavity several of the shots are still to be
seen. Portions of the trapezoid, os magnum, and scaphoid bones
appear to have been absorbed. ( Presented by Dr. L. H. Lees,
Civil Surgeon, Akyab.)

17. Chronic morbus coxse, resulting in the absorption of cartilage from

the head of the femur (left), which is atrophied and carious ; and
softening of the ligaments of the joint following inflammatory
thickening. The teres ligament has apparently been destroyed.
No history.

18. A dry preparation showing extensive caries of the head of the

right femur, and of the corresponding acetabular cavity of the
ilium, from suppurative disease of the hip-joint, The whole
of the articular cartilage covering the head of the femur was
disorganized, exposing rough carious bone ; the round ligament
destroyed, and a portion of the femoral head above the attach-
ment of this ligament absorbed. About an inch below the
great trochanter, on the anterior aspect of the bone, is an
opening, the size of an eight-anna piece, and another, nearly as
large as a rupee, on the inner aspect of the neck. Both these
lead into a large hollow cavity, occupying the great trochanter
and upper part of the shaft. This was found filled with purulent,
disintegrating osseous tissue. The cartilage investing the
acetabular cavity was also more or less destroyed, leaving the bone
bare, carious, and greatly thinned, but not perforated. The soft
structures around the joint were pus-infiltrated, the muscles
gangrenous-looking.

Ihc subject was a native (male), aged 35, who died in hospital. (“ Sur-
1Q Sic.al Post-mortem Records,” Vol. I, 187G, pp. 345-46.)

19. Excised head of the right femur, from a native girl, aged seven,

who had suffered from disease of the hip-joint for about 18
months. The bone has been removed just below the trochanters
I he art icular surface of the head is rough, bare, and almost
denuded of cartilage. The compact bony tissue has also, for the
most part, disappeared, and the cancellous structure is very soft

88 DISEASES OF THE JOINTS. [serie3 iii.

and friable. The great trochanter presents a semi-cartilaginous
condition. The acetabulum was quite healthy. (Presented by
Professor H. Gayer, m.d.)

20. Head of the left femur, excised for suppurating hip-joint disease.
From a Mahomedan boy, aged 12 years.

The bone has been removed on a level with the base of the great
trochanter. The head of the femur is seen rough and bare ; the
investing cartilage had almost entirely disappeared. The neck is
short, and set at a very obtuse angle with the trochanter major ;
the cancellous tissue of both these parts was abnormally soft and
vascular. The acetabulum was healthy. (Presented by Profes-
sor PI. Gayer, m.d.)

21. The right os innominatum, showing great expansion of the acetabu-

lar cavity, with an exuberant, tuberculated growth of new osseous
tissue around the brim, and extending upwards as far as the
inferior curved line of the ilium. (The crest of the latter is also
somewhat expanded and rough.) The diseased condition is
probably due to chronic rheumatic arthritis and ostitis, but
there is no history of the specimen on record.

22. Complete bony ankylosis of the hip-joint. A considerable quantity

of new bone — rough, tuberous, andacieular — has also been thrown
out in the neighbourhood of the joint, especially over its superior
and internal aspects, and the posterior surface of the upper third
of the shaft of the femur is thickened from the same cause.

23. Perfect bony ankylosis of the right hip joint. The head of the

bone is placed at right angles to the shaft ; its cancellous struc-
ture (as may be seen in the vertical section which has been
made) blends completely with that of the acetabulum. The
compact tissue of the shaft of the femur is thickened above,
thinned towards the lower end ; and here .also the medullary
canal is expanded. Both the femur and the portion of ilium
preserved are light and slender, and the inferior epiphysis of the
former is wanting, all of which are indications that the subject
was a young child. No history.

24. Acute synovitis of the left knee-joint. The serous membrane of

the joint is thickened and swollen ; in parts, ruptured and softened.
The cartilage investing the under surface of the patella and
outer condyle of the femur is superficially eroded. “ There
were burrowing abscesses in the popliteal space, and effusion of
lymph between the muscles in the same region.” (Presented by
Professor Harrison.)

25. “ Preparation showing general thickening and alteration of the

synovial membrane of the knee-joint, partial ulceration of the
articular cartilage of the condyles of the left femur, and of the
outer half of the corresponding patella ” (Ewart). The semi-
lunar fibro- cartilages arc thickened ; the mucous and alar liga-
ments destroyed. No history.

26. Bight knee-joint, exhibiting the effects of chronic inflammation, viz.

thickening and opacity of the synorial membrane ; softening of the
ligaments ; ulceration of the articular cartilage over both condyles

8ERIES III.]

DISEASES OF THE JOINTS.

28.

29.

30.

31.

of the femur, and outer half of the patella; the deepest ulcera-
tion existing in the intercondyloid groove, where also the subja-
cent bone is exposed.

Left knee-joint opened from behind. “ There is extensive destruc-
tion of the articular cartilage of the condyles of the femur and
of the head of the tibia, with great alteration and thickening of
the remaining synovial membrane” (Ewart). The inner semi-
lunar fibro-cartilage is deeply ulcerated and partially absorbed,
the outer has been completely destroyed.

“ Knee-joint (right) opened, illustrating extensive ulceration
and destruction of the articular cartilages of the patella, of the
tibia, and condyle of the femur ” (Ewart). The head of the
tibia, especially its outer half, has been greatly absorbed, and now
forms a deep cup-shaped cavity with carious bony walls, the
cartilage having entirely disappeared. The synovial membrane
exhibits pulpy softening, and the growth of delicate villous excre-
scences over portions of its internal surface. No history.

An opened knee-joint (right), showing great thickening and
expansion of the synovial membrane, with “ ulceration and peel-
ing-off of the cartilage of the condyles of the femur ” and head
of the tibia. “ A large abscess” at the lower and outer part
of the thigh, “communicates with the interior of the joint.”
(Presented by Professor O’Shaughnessy.)

Extensive ulceration of the cartilages of the left knee-joint ;
thickening and vascularity of the synovial membrane ; and caries
ol the articular ends of the bones. A rod is seen projecting into
the joint through an opening, the size of a crow-quill, in the head
of the tibia. The disease had apparently spread to the joint from
this bone. ( Presented by Dr. Baddeley.)

The diseased knee-joint of a patient who died in the hospital,
showing “ ulcqj-ation of the articular cartilages and of the sub-
jacent bone, with efforts at reparation,” by means of an opaque,
fibrous, cicatricial tissue covering the ulcers, and commencin'’-
eburnation of the osseous surfaces. ( Presented by Professor

Allan Webb.)

Chrome disease of the right knee-joint. There is extensive
necrosis of the head, of the tibia, as well as erosion of the
.articular cartilage investing it and the outer condyle of the

No history lgaments genera% are softened and destroyed.

Scrofulous or strumous disease of the left knee-joint. The articular
cartilage from the condyles of the femur, from the patella, and from
the head of the tibia has been almost entirely removed. The
internal semilunar fibro-cartilage is destroyed, the external
' kn“ed an^ ulcerated. Both condyles of the femur, the patella,
and the inner half of the head of the tibia are extensively carious •
the inner condyle showing, further, a circular, almost detached
. ques unn, the size of a hazel-nut, on its inferior aspect The
ligaments and synovial membrane of the whole joint are opamie

and°c(mncctive r * of degeneration. The muscular’
conncctn e tissues all round the joint arc thickened and matted

90 DISEASES OF THE JOINTS. [series hi.

together. The articular extremities of the bones are soft,
friable, and porous. ( Presented by Professor O’Shaughnessy.)

34. Eight knee-joint, showing pulpy degeneration of the synovial

membrane ; softening and erosion of the articular cartilages ;
and great thickening and infiltration of the surrounding soft parts.
The joint appears to have been immovable from soft ankylosis.
The disease is said to have been “ scrofulous.”

35. Injured right knee-joint. At the upper and inner aspect of the

internal condyle, the articular cartilage has been chipped off, over
a space an inch long and half an inch wide, of oblong shape.
The bone here is rough and exposed, and communicated with
burrowing abscesses in the neighbourhood. “ The patient, Shaik
Azzier, a Mahomedan coachman, aged sixteen years, was
admitted into hospital with a lacerated and punctured wound
over the inner aspect of the upper part of the joint, caused by
the sudden falling of a horse on which he was riding. The
thigh was amputated ” on the third day after admission, but
the patient died.

36. Right knee-joint, showing ulceration and removal of large patches
of the articular cartilage from the upper part of the outer, and
lower and back part of the inner condyle of the femur, from
the inner half of the tibia, and outer two-thirds of the patella,
with caries of the subjacent bone in all these situations.
{Presented by Professor J. Fayrer, M.D., &c.)

37. “ Destructive inflammation in and around the left knee-joint,

following a contused wound on the inner side of the joint. Roth
above and below the joint are abscesses, whose sides are now
held apart with glass rods. The joint contained pus when
opened. The synovial membrane around the patella is greatly
thickened; when fresh, it was of deep crimson colour, and pulpy
consistence. The anterior crucial ligament was so softened that
it tore across on flexing the knee. The semilunar cartilages
are detached from the tibia and completely disorganized. The
cartilage on the edge of the inner condyle of the femur, and on
the upper edge of the patella is completely absorbed, the*bone
being exposed ; that covering the inner articulating surface of
the tibia is almost quite detached from the bone, from which
it can be readily stripped. Amputation was performed seven
weeks after the injury” (Colies). The patient, however, died from
osteo-myelitis of the femur and pyaimia {see Preparation 119,
Series II).

38. “ Destructive inflammation in and around the right knee-joint,

following a wound (opening into the joint), inflicted accidentally
on himself by a Hindu, aged 21, while cutting grass. Amputa-
tion was performed twenty days after the injury.

“ There is a large abscess with ragged walls in the popliteal space, and
another over the outer condyle of the femur. The synovial
membrane round the patella is thickened and pulpy, and there
is extensive destruction of the articular cartilage over both
condyles (especially the inner), and on the internal articular
surface of the tibia ” (Colies).

SERIES III.]

DISEASES OF THE JOINTS.

The patient died after amputation at the hip-joint had been performed
for osteo-myelitis following the primary amputation of the
thigh.

39. Acute suppurative synovitis. The interior of the right knee-joint

is exposed. It was found to contain about four ounces of grumous
pus, and shreds of dark slough derived from the synovial mem-
brane. The latter was throughout highly vascular, pulpy-looking,
and swollen, and portions had not only a sloughy appearance,
but actual sphacelus had occurred of a part of the superior
fold of the same. Thus perforation of the joint, and burrowing
of its purulent contents — upwards and outwards beneath the
tendon of the vastus externus — had taken place. The ligaments
of the joint were softened and abnormally vascular ; the articular
cartilage not affected.

40. The left knee-joint of a Hindu (male), aged 25, showing chronic
synovitis, with the presence of numerous warty growths or
vegetations covering almost the whole of the inner surface of
the serous or synovial membrane, which is greatly thickened and
leathery in consistency, and, in the recent state, was highly
vascular and injected throughout. The articular cartilage seems
thinned over both condyles of the femur and head of the tibia,
but is not eroded or ulcerated, and the subjacent bony structures
(divided longitudinally), were found quite healthy.

41. Suppurative Synovitis (Pyaemic).— The left knee-joint of a native

female, aged 50. The whole of the synovial membrane is much
thickened, of a bright rosy-pink colour (in the fresh state),
and highly vascular. The joint contained fully four ounces of
thick yellow pus. The cartilage covering the lateral aspects
of both condyles of the femur is eroded, and the bone exposed and
highly vascular. The cartilage has been removed over a small
space,— the size of a split pea, — at about the centre of the inferior
aspect of the external condyle, and also at the centre of the under
surface of the patella, for a space the size of a four-anna piece.
The crucial and other ligaments of the joint arc soft, swollen,
and highly injected. The medulla of the femur was abnormally
vascular, semifluid, and pus-infiltrated (osteo-myelitis) ; that
of the tibia unaffected.

The patient received a superficial injury (a contusion) on the ulnar
aspect of the right forearm. This was followed by local suppura-
tion, burrowing abscesses formed, and the ulna became partially
denuded of periosteum. Fever, with rigors, supervened; the
left knee-joint then swelled (no other joints), and ultimately
dysentery of severe type complicated the case and caused the
patient’s death. ( See further, “ Medical Post-mortem Records,”
Vol. 1, 1873, .pp. 209-10.)

| 42. Gonorrhoeal Rheumatism.— The left knee-joint of a native male,
aged about 40. There was intense vascularity of the synovial
membrane and of the ligaments of the joint, which latter also
presented a pulpy, softened condition. The cartilage investing
the inferior surface of the condyles of the femur is seen

92 DISEASES OF THE JOINTS. [series iii.

superficially eroded over two or three small, strictly circumscribed
spots. The articular cavity contained about half an ounce of
thick yellow pus. The right knee-joint, and the right shoulder,
elbow, and wrist-joints all presented the evidences of recent acute
synovitis. (Nee further, “Surgical Post-mortem Records,” Vol.
I, 1S75, pp. 179-80.)

43. Acute disorganization of the left knee-joint of a native female,

aged 20 years. The limb was amputated at the lower third
of the thigh, on account of hectic fever of a fortnight’s
duration. The joint had been inflamed for three weeks, but there
was no history of any external injury, nor of gonorrhoea,
syphilis, &c.

The fibro-cartilages of the joint are seen almost entirely destroyed,
the articular cartilages extensively eroded, and in parts this
reaches the bony surfaces of the femoral condyles and tibial
head, which are roughened and highly vascular (in fresh state).
The ligaments and synovial membrane were found softened,
pulpy, and pus-infiltrated. The patient died after the opera-
tion from osteo-myelitis and pyaemia ( see Preparation 123,
Series IT). ( Presented by Dr. Edward Lawrie.)

44. R ight knee-joint, showing an extensive villous or warty condition
of the synovial membrane, opacity and thickening of the
ligaments, almost complete denudation of the cartilagenous
articulating surfaces of the femur and tibia, and superficial
erosion of the bone at these situations, all these changes being
ducf to chronic arthritis. Prom a native (male), aged 45, who
died in hospital.

45. Knee-joint (right), exhibiting extensive ulceration of cartilage,

and denudation with superficial necrosis of the articulating
surfaces of the tibia and femur. These changes were associated
with large burrowing abscesses in the thigh and leg, all connected
with the disorganizing joint. Half an ounce of pus was
evacuated on opening the joint post-mortem. There was no
history of injury, but the disease was acute, apparently only
of six weeks’ duration. No other joints were affected. — From
a native male patient, aged 35. (“ Surgical Post-mortem

Records,” Vol. I, 1877, pp. 447-48.)

46. A preparation illustrative of soft or fibrous ankylosis of the right
knee-joint, the result of chronic inflammation. The joint had been
kept flexed for five months. Short bands of fibrous tissue
extend between the opposed surfaces of the fibro-cartilagcs and
osseous structures of the articulation. The former are delicate,
and have to a great extent been broken down on forcibly opening
up the joint ; the latter are thicker and firmer. The bony
surfaces are extensively denuded of cartilage, and superficially
eroded. The head of the tibia is very soft, dry, and brittle.
From a native male, aged about 30.

47. Scrofulous or strumous disease of the right knee-joint. The whole

joint is disorganized, and was almost completely ankylosed. On
forcing it open on post-mortem, the union between the inner

SERIES III.]

DISEASES OF THE JOINTS.

condyle of the femur and the tibia was so firm, that a portion
of the former gave way, and may be seen still adherent to the
inner articular surface of the tibia. The cancellous tissue is
very soft, brittle, and infiltrated with caseous or fatty material.
The external condyle of the femur is almost completely denuded
of cartilage, and short bands of thickened fibrous tissue pass
between it and the outer articular surface of the head of the
tibia. The patella is drawn upwards and outwards, and fixed at the
intercondyloid notch of the femur. All the ligaments of the
joint are more or less softened and disorganized.

A large unhealthy sinus, discharging pus, was situated on the anterior
and outer side of the joint, and a glass rod now shows its
direction, upwards and inwards, through the softened bony tissue
of the head of the tibia into the knee-joint itself.

The patient was a Hindu, aged 31; the duration of the disease about
nine months. He improved greatly under local and constitu-
tional treatment and rest, and was about six months in hospital,
when suddenly he had a smart attack of haemoptysis (“without
any premonitory symptoms”). This recurred profusely after
two days, and was the immediate cause of death. A small
excavation wras found at the apex of the left lung, with deposit
of miliary tubercle in and around it for some distance.

48. “ Osseous ankylosis of the knee — broken down partly during life,

partly after death. Case of liajbullub, aged 29. It appears
that about eight years ago the patient had suffered from in-
flammation of the right thigh involving the knee, but on ad-
mission into hospital he stated that the immobility and
painfulness of the knee-joint had only existed for the last
three months. He was placed under chloroform, and the knee,
which was flexed nearly to a right angle, wras flexed to
an angle of 20°, and then extended to an angle of 120°,
beyond which no justifiable degree of force would move it.
Some adhesions, supposed to be fibrous, were felt to give w^ay
at the time. The patella remained as it had been, and wras till
death united to the anterior surface of the femur. In a few
days after the extension, an abscess formed above and to the
outer side of the knee-joint, from which pus mixed with a large
quantity of coagulated blood escaped. The abscess continued
to burrow up among the muscles at the back and outside of the
thigh in spite of frequent counter-openings. The knee-joint,
however, presented no signs of swelling, nor any marked ten-
derness ” The patient gradually sank from exhaustion, and
died about a month after the operation. On 'post-mortem
examination, the knee-joint was found to “ communicate with
the abscess in two places, above and outside the patella, and
at the back of the joint, where, through an opening in the
ligaments, the posterior surface of the outer condyle could
be felt denuded and rough. There was hardly a trace of cartilage
left in the joint. Bony union had taken place between the
patella and the front of the outer condyle, but was torn
through on reflecting the patella to examine the joint. Similar

DISEASES OF THE JOINTS.

[series hi.

bony union had also taken place between the lower surfaces of
the condyles and the corresponding surfaces of the tibia, but
were found to have been broken down in extending the joint
during life. The rough surfaces of the torn bony ankyloses
are well seen. The bones were soft, readily pierced with the
knife ” (Colies). ( Presented by Professor J. A. Purefoy Colles,
M.'D , &c.)

49. Extensive disorganization of the right knee-joint, with partial
bony ankylosis. The latter, found between the condyles of the
femur and the tibia on exposing the joint, breaks down
easily. The articular cartilage has almost entirely disappeared
from the condyles of the femur, which are bare and rough, the bone
excavated and necrosed. On the inferior aspect of the external
condyle may be seen a sequestrum, about the size of a small
hazel-nut, still invaginated by rough carious bone, and imme-
diately below this a somewhat larger excavation holding a
loose sequestrum (now fixed by pins). The articular surfaces of
the tibia are also deeply excavated and necrosed ; the cartilage
absolutely wanting. The patella is hollowed out on its inferior
surface, and partially denuded of cartilage. All the ligaments
of the joint are more or less destroyed, their remnants are
thickened and opaque. The disease is said to have been of six
years’ duration ; its origin doubtful.

There were burrowing sinuses around the joint, which itself contained a
considerable quantity of pus, was semi-flexed, and partially
ankvlosed. Amputation was performed at the lower, third of
the thigh. — From a native male patient, aged 38 years. (Pre-
sented by Professor Iv. McLeod, M.D.)

50. Right knee-joint, almost immovably ankylosed. The tibia and
fibula are bent backwards at an acute angle, owing to the con-
traction and shrinking of the hamstring tendons, and terminate
in a conical stump about four inches from the joint. — From a
native male (Hindu) aged 25, of intemperate habits, and with
calcareous degeneration of the peripheral vessels (arteries). The
leg was amputated three years previously for dry gangrene of
the foot. The patient was re-admitted in 1874 with similar
gangrene of the left foot and leg, and died from exhaustion
and dysentery before any operative interference could be under-
taken. The femoral, popliteal, and tibial arteries of the left
side were found on post-mortem examination partially calcified,
and greatly contracted in calibre, from the profunda femoris
downwards. In this preparation, the vessels (popliteal and
tibial) are pervious throughout, i.e. as far as they can be traced
into the stump ; they are, however, much contracted and rigid.
The internal popliteal nerve presents a bulbous enlargement at
its termination in the stump. ( See further, “ Surgical Post-mortem
Records,” Vol. I, 1874, pp. 81-82.)

51 Deformity of the right knee-joint, the result of disease. The
patient, a Mahomedan, aged about 40, stated that about
fourteen months ago he first noticed that the joint was swollen

SERIES III.]

DISEASES OF THE JOINTS.

and painful. The swelling gradually increased for some months,
but at last subsided “by bursting of itself,” and then the leg
became displaced backwards. There was a history of syphilis
followed by mercurial salivation. The preparation exhibits a
spontaneous dislocation, backwards and outwards, of the tibia
and fibula from the femur. The condyles of the latter project
sharply beneath the skin, and are well defined in this position,
as is also the patella, which is seen immovably fixed in the
superior intercondyloid fossa. The integuments over these
structures are very tightly stretched, thinned, and superficially-
ulcerated in parts.

52. “ Left knee-joint of Lieutenant C., of the Bengal Artillery, who

was shot in the knee in the attack on Dewaugiri, Bhootan, and
died of pyaemia in Calcutta. The ball, an irregular leaden
matchlock bullet, preserved with the specimen, entered the
cavity of the joint on the inside, and lodged in the inner condyle,
whence it was removed after the patient reached Calcutta. The
aperture of entrance in the skin has been preserved ; the bone
around the ball is carious and was pus-infiltrated. The interior
of the joint was quite disorganized and contained pus. The
cartilage covering the outer condyle and the back of the patella
has been partly absorbed, exposing the bone. The femur is
almost completely detached from the soft parts by the formation
of extensive abscesses. The veins of the thigh were healthy.
A large pysemic abscess had formed under the deltoid, and opened
into the right shoulder-joint, the cartilages of which were eroded.
There was a large patch of dead tissue in one lung, and a similar
one in each kidney. The heart and other viscera were healthy ”
(Colies). ( Presented by Assistant Surgeon R. W. Carter.)

53. “ Stump removed by a second operation after failure of primary

amputation at the ankle-joint, owing to deficiency in the quan-
tity of the soft parts, and necrosis of the ends of the bones. * * *
The roughened and necrosed bones can be seen protruding through
the granulating surface of the stump ” (Ewart).

54. “ Stump of a case of Syme’s amputation at the ankle-joint, showing

that adhesive union has taken place between a large portion of
the incised surfaces” (Ewart). ( Presented by Professor
J. Fayrer, m.d., &c.)

1*55. “ Left foot of a Hindu, amputated by Syme’s operation for disease
of the tarsus, caused by a brick falling upon it four years before.
There are several sinuses on the dorsum of the foot, leading down
to diseased bone. The astragalus and calcaneum are quite soft ;
a knife can be thrust through them with ease ” (Colles) .
(Presented by Professor S. B. Partridge, f.e.c.s,, &c.)

66. A dry preparation of the right foot, amputated by Syme’s method
for scrofulous disease of the tarsus. The subject was a native
(male), aged 32. All the bones of the tarsus are seen to be very
light and spongy, rarefied, and extremely brittle. The cuneiform
bones, however, seem to have suffered most. The margins of
the astragalus and cuboid are carious, and the disease has

DISEASES OF THE JOINTS.

[SEEIES III.

extended forwards to the bases of the four outer metatarsal
bones. Almost all the tarsal and tarso-metatarsal joints were
disorganized, denuded more or less of cartilage, the connecting
ligaments softened, highly vascular, and shreddy or pus-infiltrated.
The disease appeared to have been strumous in character, and to
have commenced in one or more of the tarsal articulations on
the inner side of the foot, spreading gradually to the rest. The
patient was very weak and emaciated, there was profuse discharge
from sinuses which covered the dorsum of the foot. Amputa-
tion was performed as a last resource. Death, however, was the
result, from tubercular peritonitis, &c.

SERIES IV.]

DISEASES OF THE MUSCLES, &c.

Series IV.

AND DISEASES OF MU.SCLE, &c.

r- *•*. *

INDEX TO THE SERIES.

V'/.. • ? A. -MUSCLE.

1 \ K x •'

1. — Expensive laceration, 1, 2, 3.

2. — Fatty degeneration,* 4.

3. — Acute inflammation (myostitis), G, 6.

4.— Morbid infiltration —

(a) Lymphoid (in Hodgkin’s disease), 7, 8.

( b ) Carcinomatous, f 9.

B.-BURSA.

1.— Inflammation of, 10.

DISEASES OF THE MUSCLES, &c.

1. Extensive laceration of the muscles and tendons of the palm and

back of the hand, the result of a machinery accident. Amputa-
tion through the forearm had to be performed on the fifth day
after the receipt of the injury, on account of the supervention
of tetanus.

2. “ Thumb and carpus of the right hand of a native woman, ampu-

tated at the wrist-joint, the remainder of the hand having been
bitten off by a shark. The carpo-metacarpal joint of the thumb
is also opened” (Colies).

3. “ Arm removed at its upper third from a case of shark-bite.” The

preparation is interesting in showing the terrible amount of
injury capable of being inflicted by a bite from this animal. The
limb seems to have been seized just about the bend of the elbow
and bitten through, soft parts and bone being equally lacerated
and crushed ; the joint exposed ; the flexor muscles stripped off
the front of the forearm ; a large gaping, ragged wound left above
the olecranon ; and a series of transverse lacerated wounds arc
observed at short intervals along the posterior aspect of the

* Sec also Series VI.
t See also Series XVII.

08 DISEASES OF THE MUSCLES, Ac. [series iv.

whole forearm, as if due to successive grips after the main hold
at the elbow was abandoned by the animal. Lastly, a large
lacerated wound is seen at the back of the wrist-joint, and lesser
ones over both the anterior and posterior aspects of the hand.
One of these appears to pass quite through the inner side of the
palm, and has almost detached the little and ring fingers from
the rest. [Presented by Professor J. Fayrer, m.d., &c.)

4. “ Four fragments of muscle from the plantar region, in which

extreme fatty degeneration was manifested” (Ewart). Under
microscopic examination, the transverse striae are less distinct than
normal, and there is a moderate amount of dark, granular, fatty
metamorphosis of the muscular fasciculi. No history.

5. A large mass of inflamed and disintegrating muscle (myostitis),

consisting chiefly of the adductors of the left thigh. — From a
native male, aged 20, who died from erysipelas. The muscular
fibre, though much softened, and breaking up much more readily
than normal when frayed out with needles, yet shows on micro-
scopical examination very distinct striation of the fasciculi, and
an entire absence of all degenerative change; but the sarco-
lenima is crowded at points with small round cells or nuclei, and
the interfibrillar connective tissue has considerable sized depots
of granular nucleated cells distributed throughout its extent at
irregular intervals, many of which cells appear to be true pus-
corpuscles, and undoubtedly indicate proliferative irritation.
(“ Surgical Post-mortem Records,” Yol. I, 1880, pp. 703-4.)

6. A portion of the adductor longus muscle from the inner side of the

right thigh, showing extensive suppurative softening, which was
associated with a large and spreading gluteal abscess. — From a
native male (Hindu), aged about 20, who died in hospital.

The microscopic changes are similar to those described in connection
with Preparation 5. (“ Surgical Post-mortem Records,” Yol. I,

1880, pp. 707-8.)

7. A portion of the diaphragm, exhibiting great thickening of its peri-

toneal surface, due to the presence of a lymphoid or adenoid
growth, forming in parts distinct nodular swellings, in others a
more diffuse infiltration, which extends also into the muscular
substance, and may be traced with the microscope disparting and
compressing the muscular fasciculi. The liver, spleen, kidneys,
&c.. were all similarly affected. The patient, a native female,
aged 40, was admitted into hospital suffering from anaemia, and
had a slight leucorrhceal discharge. She died, apparently from
exhaustion, on the tenth day. The morbid growths were not
suspected during life, only discovered on post-mortem examina-
tion.

8. A portion of the diaphragm with lymphoid infiltration, from a case

.of lymphadenoma, or Hodgkin’s disease: a native female, aged
25. Small granules and flattened nodules, consisting under the
miscroscope of proliferating lymphatic or lymphoid cells, are
seen to separate the muscular fasciculi, and form a distinct infil-
tration of this tissue. In some parts much fatty infiltration of
the muscular fibre accompanies the new growth, and the latter is

8EEIE9 iv.] DISEASES OF THE MUSCLES, &c.

also, here ancl there, found undergoing incipient caseation. The
lymph-glands in the anterior mediastinum, the pleura, and peri-
cardium, the mesenteric glands, spleen, and peritoneum generally
were all similary infiltrated. (“ Medical Post-mortem, Kecords,”
Vol. I, 1875, pp. 517-18.)

9. A portion of the diaphragm infiltrated with soft carcinomatous

nodules, secondary developments to an enkephaloma of the femur*
The lungs, lumbar glands, &c., were similarly affected. The
microscopic structure of these nodules is that of true enke-
phaloid cancer. (“Surgical Post-mortem Kecords,” Vol. I, 1877,
pp. 897-98.)

10. A very greatly hypertrophied bursal cyst, which occupied the

upper and inner portion of the popliteal space, and communi-
cated with the left knee-joint. The cyst is irregularly oval in
shape, and rather larger than a pomegranate. Its walls
are very thick, in parts fully half an inch in diameter. This
is due to the blending with its external surface of much of the
loose fibro-cellular tissue of the popliteal space, and of mus-
cular fibres derived from the hamstring muscles ; also to
inflammatory changes in the cyst wall itself, the inner surface of
which is coated with patches of semi-organized lymph. On
dissection, the inflamed and enlarged bursa was identified as
that which lies beneath the inner head of the gastrocnemius
muscle, and which, in this instance (as is not uncommon),
communicated with the knee-joint through an opening in the
posterior ligament. This opening may be seen in the prepara-
tion. Around it the bursal sac is much thinned.

The patient, a Hindu, aged 25, attributed the origin of the growth
to a fall from a tree three years ago ( i.e . previous to admission
into hosiptal), when he alighted on the knees, and a month after,
a small swelling was noticed by him in the left popliteal space.
It gradually increased, until it became a distinct and large
tumour, which was “ tapped ” by a native barber, and “ half
a pint of watery fluid with blood and pus” evacuated. He
died somewhat suddenly in hospital.

On 'post-mortem examination the cyst itself, as well as the knee-joint
were found filled with purulent fluid, and the interior of the
bursa, and the synovial membrane of the joint, dark and sloughy
in appearance.

The popliteal vessels were much displaced, but not involved.

100

DISEASES OF THE SPINE.

[series y.

Series V.

DISEASES OF THE SPINE.

INDEX TO THE SERIES.

A.— ANATOMICAL.

(a) Diseases of tlie cervical vertebral, 1, 2, 3, 4, 5, 6, 7.

(b) -

— dorsal ,

7, 8, 9, 10, 11, 12,

13,

14,

15,

16.

— lumbar ,

7, 8, 10, 11, 12,

17,

18,

19,

20, 21.

(d) .

sacral ,

22, 23.

— coccyx, 22.

B.— SURGICAL AND PATHOLOGICAL.

1. — Ulceration of Intervertebral cartilage, 3, 5 (?), 7, 8, 11, 12, 13,

18, 19, 20, 21.

2. — Caries of the bones, 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 17, 19,

20, 21, 22.

3. — Necrosis of the bones, 8, 10, 11, 18, 22.

4. — Ankylosis, 6, 10, 13, 14, 15, 17, 22.

5. — Angular curvature, 8, 9, 10, 12, 22.

€. — Lateral curvature, 7.

7. — Implication of spinal cord or membranes,* 8, 21.

8. — Abscess accompanying disease of spine, 20, 22.

9. — Tumours,! 5, 16.

10.— Spina bifida, J 23.

* Nee also Series I and VIII.
t See also Series XVII.

% See also, with other congenital diseases, Series XVIII.

SERIES V.]

DISEASES OF THE SPINE.

101

DISEASES OF THE SPINE.

1. Caries of the anterior arch and articulating processes of the atlas.

No history.

2. Caries of the whole of the second cervical vertebra. No history.

3. Caries of the sixth cervical vertebra, with softening and ulceration

of the intervertebral fibro-cartilage between it and the vertebra
prominens (seventh). No history. (Presented by Professor
Edward Goodeve.)

4. Superficial caries (syphilitic) of the axis and third cervical vertebra,

due to the pressure of a gummatous tumour, which grew in this
situation, and had apparently developed from the anterior com-
mon ligament or periosteum, and pressed upon the pharynx
and upper part of the larynx, having attained the size of “half
a hen’s egg.” From a European. (Presented by Dr. A. Vans-
(Best, Presidency General Hospital.)

5. “ Cervical vertebra? of Bhuban, aged 19 years, operated upon on the

21st February 18G9, for a cystic tumour on the right side of his
neck. The tumour was attached to the intervertebral groove
of the second and third cervical vertebrae ” (Colies). The bodies
of the second and third cervical vertebrae are seen hollowed out
on the right side by the growth of the above cyst ; and the inter-
vertebral cartilage in this situation seems also to have become
absorbed.

6. Firm bony ankylosis of the second and third cervical vertebrae.

No history.

7. “ Five, cervical, and the whole of the dorsal and lumbar vertebrae.

Caries of a part of the body of the second dorsal, of the
articulating surfaces of the 11th and 12th dorsals, with

destruction of the intervertebral cartilage. There is a slight
curvature in the upper part of the dorsal region, formed by the
2nd, 3rd, and 4th dorsals, the convexity being sinistral. A
second greater curvature lower down, constituted by the last
four dorsal vertebrae, displays a dextral convexity. A third
extreme curvature is formed by the diseased second and third
lumbar vertebrae, and possesses a sinistral convexity ” (Ewart).
No history.

8. Caries of the sixth and seventh cervical, and of the bodies of all

the dorsal and upper three lumbar vertebrae. “ The upper eight
c orsal. vertebrae are much affected, and the bodies of the seventh
und eighth are destroyed, exposing the dura mater of the cord.
^ is here that considerable curvature ” (posterior, angular)
has taken place ” (Ewart). No history. (Presented by Professor
1- W. Wilson.)

9- A longitudinal section through five dorsal vertebrae, illustrating
angular curvature of the spine, “ due to the degeneration and
interstitial and molecular absorption” (caries) “of the interver-
tebral cartilage with the greater portion of the body of one
vertebra ” (Ewart). No history.

102

DISEASES OF THE SPINE.

[SEEIES V.

10. A portion of the spinal column, exhibiting a double posterior

curvature, the result of carious destruction of the vertebra? ;
one curvature at the upper part of the dorsal region, the other
at the dorso-lumhar junction. The bodies of the seventh cer-
vical, all the dorsal, and all the lumbar vertebrae are diseased. *
The anterior portions of the bodies of the last cervical and
first dorsal vertebrae are excavated, and the spine prominent
opposite this, the spinous processes and laminae of these vertebrae
having coalesced (ankylosed).

The principal curvature, and greatest destruction of hone has taken place
in the dorso-lumhar region ; the greater portions of the bodies
of the seventh dorsal to third lumbar inclusive having been
absorbed, their remains carious, porous, and spongy, and
an acute posterior angular curvature developed by the approxi-
mation of the vertebra? above and below the gap, with bony
ankylosis between the laminae and spinous processes of the
eighth, ninth, and tenth dorsal vertebra? above, and the first and
second lumbar below. Taken from an East Indian lad, aged
about 17 years. ( See further, “ Surgical Post-mortem Records,”
Yol. I, 1875, pp. 130-40.)

11. The whole of the dorsal and lumbar spine, showing caries of all

the vertebrae of the former and of the first lumbar. The
eleventh dorsal is excavated, leaving a gap an inch wide, in which
the spinal cord is exposed, but apparently not injured. The
membranes are entire. The ribs on each side of the dorsal
vertebrae, for about two inches, arc also carious, and their arti-
culations exposed. From a native girl, aged 10 years,

12. Caries of the bodies of the last three dorsal and first three lumbar

vertebrae, with ulceration of the corresponding intervertebral
cartilages, and a posterior angular curvature in the dorso-lumhar
region.

13. “ Carious degeneration of two dorsal vertebrae with interstitial

absorption of the intervertebral cartilage. Partial reparation
by ankylosis has taken place on the right side” (Ewart). No
history.

14. “ Caries of the bodies of four dorsal vertebrae ” (Ewart). Firm

ankylosis has taken place between the articular and spinous
processes of these vertebrae by means of bridges ot newly-formed
bone.

15. “ Partial ankylosis of five dorsal vertebrae by a deposit of osseous

material in, or by ossification of, the anterior common ligament ”
over the front and right lateral aspects of the spine. No
history.

16. “ A bony tumour on the left side of the dorsal vertebrae, which

pressed upon and obstructed the descending aorta” (Ewart).
No history.

Only the osseous shell of the growth is now left, which is the size of a
small orange, smooth and rounded.

17. Caries with excavation of the greater portion of the bodies of the

first and second lumbar vertebra?. Bony ankylosis, without
curvature of the lumbar portion of the spine, has taken place.

SERIES V.]

DISEASES OF THE SPINE.

103

18. Necrosis of the upper half of the second lumbar vertebra, with

ulceration and partial absorption of the intervertebral fibro-
cartilage between it and the first lumbar. A small portion of
the necrosed body of the second vertebra may be seen still in
situ, as well as the exfoliation of the superficial lamina of tho
body of the first lumbar vertebra.

19. “ Caries of a portion of the body of the fourth lumbar vertebra,”

with ulceration and partial removal of the intervertebral cartilage
between it and the third vertebra. ( Presented by Dr. Theodore
Cantor.)

20. “ Preparation showing a section of lumbar and three lower dorsal
vertebrae in a case of fatal lumbar abscess. The ulcerative
destruction of the cancellous osseous structure and the disintegra-
tion of the intervertebral cartilage is admirably illustrated”
(Ewart).

21. A portion of the spinal column from a case of paraplegia with

lumbar pain, &c.— an adult European (male). There is caries of
the last dorsal and first lumbar vertebrae, the latter much
softened, and breaking down on removal into several pieces.
The intervertebral cartilage between these vertebrae had been
almost entirely removed by ulceration and absorption, and the
opposed bony surfaces of the latter present a roughened and
eroded appearance. Indeed, about one half (the upper) of the
first lumbar vertebra has quite disappeared. A portion of the
cord, corresponding to the seat of the diseased bone, was found
“ softened and diffluent,” accounting for the paraplegia.

22. Caries of the anterior surface and transverse ridges of the sacrum

and anterior aspect of the coccyx, with necrosis and separation '
of a portion of the left lateral mass, and coalescence of the first
and second sacral foramina. The three last vertebra? of the
coccyx are ankylosed, and fixed at a right angle to the first by
means of strong fibrous bands. During life an abscess surround-
ed this terminal portion of the spine. {Presented by Professor
Allan Webb.)

23. “A preparation of the spinal column, showing spina bifida”

(Ewart). No history. The hiatus is formed by the absence of
the lamina? of the sacral vertebra?. The tumour is the size of an
orange, intimately adherent to the skin. It is lined by the dura
mater of the cord. The latter is seen to divide into two bundles
(fasiculi), one of which, tho anterior, blends with, and its filaments
spread out upon, the inner surface of the cyst; the other, the
posteiioi, ti averses the cavity of the cyst at its centre, reaches
the posterior surface of the same, and is distributed over it. A
tubular prolongation of the pia mater surrounds each of these
divisions of the cord.

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PA.RT III.

INJURIES AND DISEASES OF THE
PERICARDIUM, HEART, ARTERIES, AND VEINS.

Series VI.

SERIES VI.]

107

Series VI.

INJURIES AND DISEASES OF THE PERICAR-
DIUM, HEART, ARTERIES, AND VEINS.

INDEX TO THE SERIES.

A.-THE PERICARDIUM.

1. — Acute pericarditis, 1, 2, 3, 4, 5, 6, 7, 8, 9.

2. — Hydro-pericardium-, 10.

3. — Pro , 11.

4. — CnRONic pericarditis (including partial or complete adhesion,

thickening, calcareous deposit, &c.), 12, 13, 14, 15, 16, 17, 18,
19, 20.

5. — Attrition and other marks (“white patch”), 21, 22, 23, 24.

B.-THE SUBSTANCE OF THE HEART.

1.— Rupture —

( Left ventricle, 25.

) Right , 26, 27.

(«) From external violence... < geJtum ,cntricn]orum, 2S, 29.

(.Both auricles, 30.

(5) From disease (spontaneous), 31 32.

2.— Gunshot injury, 33.

3. — Myocarditis, 5, 34, 35, 36, 37, 125.

4. — Suppuration (pyoemic), 38.

5. — HAEMORRHAGE INTO SUBSTANCE OF HEART, 39, 40.

6. — Atrophy of entire heart, 41, 42, 43, 44, 45, 182, 183, 185.

7- — Hypertrophy of one or more parts of the heart without pro-
portionate dilatation,* 46, 47, 43, 49, 50, 5 1 ,t 52, f 53, t
54, f 55, f 56, f 131.

Hypertrophy and dilatation in about equal proportions, 57, 58,
59, 60, 61, 62, 63, 64, 115.

9.— Dilatation, genkral. of one or more parts of the heart, without
proportionate hypertrophy, 65, 66, 67, 68, 69, 70, 71, 72,
73, 74, 75, 76, 77, 78, 79, 186.

10- “Dilatation, partial or local (aneurismal pouching). 31, 80, 81,

82, 83, 84, 85, 86, 100.

11— Degeneration of muscular structure —

r Infiltration, 87, 88, 89, 90.

(a) Fatty ... ] Metamorphosis, 32, 35, 63, 69, 87, 91, 92, 93, 94,

( 186.

(b) Fibroid (induration), 95, 96, 97.

those marked thusf were associated with Morbus Brightii. Nee also Series XI.

108

INDEX.

[series VI.

12.— Morbid growths —

(a) Carcinomatous, 98, 99.

( b ) Syphilitic or gummatous, 100.

C.— THE VALVES OF THE HEART, THETR APPENDAGES, AND

THE ENDOCARDIUM*

a. m.

1. — Laceration of chord2e tendine;e and valve-flaps, 101, 102.

2. — Thickening or induration (with or without contraction of valve-

a . a. a. a. a. m.

flaps, or adhesion to neighbouring parts) 60, 64, 66, 67, 68,
m. m. m. m. m. m. m. m.-t. m. a.-m. a. a. in.

70, 75, 81, 85, 103, 104, 105, 106, 107, 108, 109, 110, 111,

a. m.-a. m.-a. a. m. m. m.-a. a .

112, 113, 114, 115, 116, 117, 118, 119-

a.-m.

3. — Thickening or induration with calcareous infiltration, 61,

a.-m. a. m. m. a -m. a. a. a. a.-m. a.-m. a. a.

63, 101, 103, 105, 108, 109, 120, 121, 122, 123, 124, 134,

135.

4. —Ulceration, fissuring, or perforation (old or recent) of valve-

a. a. a . a. a. a. a. m. a. a. a.

FLAPS, 63, 101, 108, 113, 115, 119, 120, 122, 125, 126, 127,

a. a.-m.

128, 131.

m. m.

5. — Aneurismal or touched CONDITION OF VALVE-FLAPS, 129, 130.

6. — Deposits connected with the valves or endocardium —

(a) Inflammatory (warty growths, villous vegetations, &c.), 101,

117, 120, 125, 126, 127, 128, 129, 131, 132, 133, 134, 135, 136,
137 (?), 151.

U>) Non-inflammatory (fibrinous concretions or cardiac polypi,
undergoing change or not), 85,98, 117,138, 139, 140, 141,
142, 143, 144, 145, 146, 147, 148, 170.

7. — Malformations of the heart and its appendages (valves,

arteries, &c.) —

fa) Bifid apex, 149, 150.

(b) Perforation or arrested development of the septum ventri-

culorum, 151, 152, 153, 154.

158, 159, 160.

(d) Pulmonary valves, two in number, 161, 162.

(e) , four in number, 163.

(f) Aortic valves, two in number, 164, 165, 166, 167, 168, 169.

((f) Hypoplasia of aorta, 170.

(h) Fenestration or cribriform condition of the valves, 171, 172,
173, 174, 175, 176, 177, 178, 179, 180.

* The valve* affected are indicated by the letters placed over the number of the prepara-
tion, thus a ^-aortic, w=mitral, a.-m. or m.-a= aortic and mitral, wi.-f=initral and tricuspid,
and so on.

SERIES VI.]

INDEX.

109

8. — Preparation from the horse, 181.

LJ •

4. -

5. —

1.—

D.— DISEASES OF THE BLOOD-VESSELS OF THE HEART
(CORONARY VESSELS).

1. — Atheromatous (including calcareous) degeneration, 50, 121, 182,
183, 184, 185, 186.

-Aneurismal dilatation, 187.

-Abnormal origin, 32, 64, 188, 189.

E.— ARTERIES.

(a) Injuries of arteries —

■Rupture from external violence, 190, 191, 192, 193, 194.

■Rupture in hanging (criminal), 195, 196, 197, 198.

•Consequences of application of ligature, 199, 200, 201, 202.

Formation of simple fibrinous coagula (false thrombosis), 203.
204.

Ulceration and invasion by malignant growth, 205.

(b) Diseases of arteries —

Atheroma, with or without calcareous infiltration —

{a) Aorta (thoracic), 206, 207, 908, 209, 210, 211, 212, 213, 214,
215, 216, 217, 218.

(/?) Aorta (abdominal) and common iliac arteries, 208, 210, 213 219
220. 221, 222, 223, 224.

(71 Pulmonary artery, 225, 226.

(S Arteries of upper extremity, 227. 228.

(e) Arteries of lower extremity, 229, 230, 231.

(?) Mesenteric artery, 232.

Thrombosis, 2*'8, 233.

General dilatation (aorta), 207,210,211,214, 220,223,234 246
257, 259, 260, 262, 296.

Partial dilatation (aneurism) —

Thoracic aorta (arch), ascending portion, 235, 236 237 238 939
240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250,251,’ 252!
2o3, 254, 255, 256, 257, 258.

Thoracic aorta (ar.ch), transverse portion. 238,215,251 256 258
259,260,261,262,203,264, 265, 266, 267, 268, 269,’ 27<>!

2/0a.

Thoracic aorta (arch), descending portion, 266, 267, 271, 272, 273
274, 275, 276, 277.

Thoracic _aorta, below arch, 276, 278, 279, 280, 281, 282, 283, 284,
28o.

Abdominal aorta, 286, 287, 288, 2S9, 290, 291, 292, 293, 294, 295

295a. ’

Innominate, 252, 259, 265, 267, 296, 297, 298.

Common carotid. 299, 300, 301.

Subclavian, 302, 303.

External iliac, 304, 305.

Popliteal ,* 306, 307.

* For aneurism ot the cerebral arteries, see series VIII.

2.-

3. -

4. —

110

INDEX.

[SERIES VI.

5- — Sac formed by limited portion of wall of artery —

(a) With integrity of all the coats (true aneurism), 236, 245,
249, 253, 255, 258. 259, 268, 269, 270, 270a, 271, 277, 285,
288, 289, 291, 296, 298.

(/3) With partial destruction of the coats (false aneurism), 235»
237, 238, 239, 240, 241, 242, 243, 244, 246, 247, 248, 250,
254, 257, 258, 260, 261, 263, 264, 265, 266, 267, 272, 273,
274, 275, 276, 278, 280, 281, 282, 283, 284, 286, 287, 292,
293, 294, 295, 297, 302, 303, 304, 305.

(7) 8ac formed by partial dilatation and growth of the whole or
greater part of the circumference of a portion of an artery
faneurismal dilatation), 237, 241, 243, 251, 252, 256, 261,
267, 270a, 271, 297.

(S) Sac formed by the coats of the artery separated by blood
effused between them (dissecting aneurism), 264, 295a.

(e) Diffuse aneurism, 238, 300, 301, 306, 307.

6.— The aneurismal sac opening into the pericardium, 212, 244,
251, 258.

LEFT AURICLE, 236.

• RIGHT PLEURA, 280, 294.

LEFT PLEURA, 284, 287, 293.

— LUNG, 273.

trachea, 245, 270a, 296,

297.

269, 276, 282, 285

279.

LEFT BRONCHUS, 267, 268,
oesophagus, 261,271,274,
PERITONEAL CAVITY, 295.

7.— Progress of aneurisms-

( a ) Deposit of laminated coagulum in the sac (not in connection
with local treatment), 239, 2IO. 212, 245, 216. 250, 253, 261,
265, 266, 268, 270, 272, 273, 274,275,277,281,282,291,
296, 302.

(/ 3 ) Partial or complete spontaneous cure (from deposit of lami-
nated coagulum), 243, 263, 288, 289, 295a, 306.

(7) Effects of the treatment of aneurisms, 238, 299, 300, 304, 306,
307.

Effects of the pressure of aneurisms on the surrounding
parts, 235. 239, 242, 243, 245, 248, 251, 252, 254, 256, 257,
259, 260, 261, 262, 264, 265, 267, 270, 270a, 275, 277, 278,
281, 283, 284, 288, 290, 293, 298, 301.

(e) Eupture or ulcer atton of the sac, 236, 237, 238, 239, 242,
244, 245, 246, 250, 251, 257, 258, 259, 269, 270a, 271, 272,
273, 274, 276, 278, 279, 280, 282, 284, 285, 287, 293, 294,
295, 296, 297, 302, 303, 305, 307.

SERIES VI.]

INDEX.

Ill

a —Irregularity in the Origin or Distribution of arteries, 205,
214,255,259, 270, 277, 282, 294, 303, 308, 309,310 311,
312, 313, 314, 315, 316, 317, 318, 319, 320, 321, 322, 323,
324.

F.— VEINS.

1. - Incised wound, 325.

2. Consequences of application of ligature, 326, .327, 328, 329.

3 Thickening of walls (inflammatory), 32b, 327, 328, 329, 330.

4. - Veins containing fibrinous coagula (thrombosis) —

(a Recent, 329, 330, 331,* 332,* 333, 334, 335,* 336.

(l 3 ) Older (undergoing change), 327, 337, 338, 339, 340, 341.*

5. — Suppurative phlebitis, 326,* 335,* 342, 343 *

6. — Venous aneurism (hjematoma), 344.

* Associated with pyaemia.

1. Acute Pericarditis. “ The sac is opened, exposing the anterior sur-
face of the right ventricle and the roots of the great vessels.
The greater part of this is covered with shreds and laminae of
organizing lymph, some of which are of a pale brown colour/’
This fibrinous exudation is most abundant near the origins of
the aorta and pulmonary artery. “ A portion of the parietal
pericardium is reflected for the purpose of showing the coating
of false membrane with which it is furnished” (Ewart).
( Presented by Dr. J. C. Collins, of Monghyr.)

2 Acute Pericarditis. A thick, reticulated, and villous-looking layer
of soft recent lymph invests the opposing surfaces of the peri-
cardium, and in places unites them. Over the lower portion of
the anterior surface of the right ventricle the exudation has
assumed a membranous form, is especially thick and dense, and
forms bands of adhesion between the parietal and visceral layers.
( Presented by Professor Mouat.)

3- Acute Pericarditis. The exudative material forms a complete
membranous investment for the heart, from which, however, it
can readily be peeled off. It is comparatively smooth and
homogeneous instead of presenting the usual roughened and reti-
culated appearance. ( Presented by Professor Edward Goodeve.)

4 Acute Pericarditis. Great thickening of the parietal and visceral
layers of the pericardium, with an abundant exudation of lymph
between them, which is undergoing organization, and has already
served to glue together the opposed surfaces of the inflamed
membrane at certain spots. From a native female, Prossonno,
aged 35. ( Presented by Dr. C. R. Francis.)

5- The Heart and Pericardium of a Mahomedan female, aged 15, who
died in hospital from acute rheumatism with cardiac complications
after an illness of about ten clays.

The inflammatory changes found on post-mortem examination were most
intense. “ The heart is enlarged and its walls highly congested, as

112

DISEASES OF THE HEART.

[SEBIES VI.

is common in acute pericarditis and carditis, and illustrates that
condition which has been described as ‘ inflammatory swelling and
stretching,’ as distinguished from organic ‘ hypertrophy and dila-
tion.’ The pericardium is highly congested and thickened.
There was no fluid in the sac.” “ There are vegetations, probably
of recent origin, deposited along the free margins of the aortic
valves. The vegetations are not larger than a pin’s head. Others
of the same nature, but even smaller, were also found along the
lower margins of the bicuspid curtains.” ( Presented by Professor
Norman Chevers.)

6. Acute sero-fibrinous Pericarditis. The pericardium is enormously
. thickened ; both parietal and visceral layers are coated with
recent lymph, forming a rough and shaggy deposit over the
entire cardiac surface, and over the intra-pericardial portions of
the large vessels at its base. The pericardial sac was found
distended with about twelve ounces of turbid yellowish serum,
in which were suspended large flakes of recent lymph.

The specimen was taken from a Hindu female, aged 28, suffering from
acute rheumatism, and brought into hospital in a moribund
condition. The pericarditis was diagnosed during life.

7 Acute sero-fibrinous Pericarditis. Both parietal and visceral layers
of the pericardium are acutely inflamed, and covered with a
thick layer of recent, soft, reticulated lymph. Three ounces of
turbid serous fluid, with flakes of similar lymph suspended in it,
were found effused between the inflamed and opposing layers.
Taken from a native male, aged 23, who died in hospital. (“ Medi-
cal Post-mortem Records,” Yol. II, 1877, pp. 487-88.)

8. Heart showing the effects of recent acute pericarditis. Both

layers of the pericardium are covered by a thick layer of recent
rosy lymph, having a rough, granular, and rugose appearance.
Six ounces of turbid yellowish serum were also found in the
pericardial cavity.

From a native male, aged 42, who died in hospital. (“ Medical Post-
mortem Records,” Yol. IT, 1878, pp. 687-88.)

9. The Heart and Pericardium from a case of acute sero-fibrinous

pericarditis, — a native (Mahomedan) male, aged 40. Both
parietal and visceral layers are highly inflamed, and covered by a
thick layer of yellowish reticulated lymph, which also glues them
together in parts. Fifteen ounces of turbid, greenish-yellow
serum, with a large quantity of flocculent lymph suspended in it,
were found in the pericardial cavity. (“ Medical Post-mortem
Records,” Vol. Ill, 1880, pp. 535-36.)

10- “Heart, and an enormously distended Pericardium, which con-
tained ninety-two ounces of fluid ” (Ewart). Both parietal
and visceral layers of the serous membrane have a thickened and
softened appearance. No history. ( Presented by Professor
Edward Goodeve.J

11. Suppurative Pericarditis associated with general pyaemia.

The preparation exhibits the heart and pericardium of a prisoner who
died in the Ravvul Pindee Jail. The sac of the latter was found

SERIES VI. ]

PERICARDITIS.

1 13

113.

14.

! 15.

16.

12.

filled with pus (pyo-pericardium), and can now be seen with its
opposed surfaces roughened and granular-looking from acute
inflammatory changes. There was a small abscess in one of the
kidneys.

The man, a Pathan, aged 30, was at first admitted into the jail
hospital for a simple ulcer of the ankle, produced by iron fetters.
After a time diffuse erysipelatous inflammation of the cellular
tissue ensued. Large collections of matter rapidly formed on
the inner sides of both thighs and on the chest, the latter
communicating with the lung below. This lung (the right) was
so firmly adherent at all points that it could not be entirely
removed at the post-mortem examination. The man lived for about
a fortnight after the abscesses on his thighs and chest were opened”
(Note by the Donor). ( Presented by J. Fairweather, Esq., m.d.,
Civil Surgeon, liawul Pindee.)

Chronic Pericarditis. “ An excellent specimen of adhesion of the
pericardium. The left ventricle is opened longitudinally. The
section, proceeding from without inwards, shows, first, a thick,
opaque white lamina, corresponding to the external pericardium ;
secondly, two brown-coloured layers, one belonging to the
external, the other to the internal pericardium ; thirdly, an
opaque white layer in the situation of the visceral pericardium,
and lying in contiguity to the muscular structure of the heart.
Ihe right ventricle is also held open, and here a portion of the
visceral has been forcibly separated from the parietal pericardium,
showing the shaggy character of the torn adventitious struc-
ture ’ (Ewart). {Presented by Mr. George Daly.)

A section from the heart and pericardium in a case of chronic
ac lesive pericarditis. “ A portion of the sac is preserved. This
is a quarter of an inch in thickness and cartilagenous in con-
sistency, roughened and irregular in its interior, and adherent
externally to the lungs, portions of which are seen attached ”
{Ewart) . {Presented by Mr. James Hinder, of Umritsur.)

‘ Universal adhesion of the parietal to the visceral layer of the
serous pericardium, of six or seven years’ standing.” The ven-
tricular walls are “somewhat attenuated,” and their cavities
occupied by firm, fibrinous coagula, which are prolonged into
the aorta and pulmonary artery on either side. (Presented bit
Dr. Green, of Howrah.) J

Chronic Adherent Pericarditis. The pericardium is hard, dense,
almost horny to the feel. In parts are seen small circumscribed
in nitrations of calcareous material into its tissue; this is most
abundant m the conjoined layers of the membrane investing
ie right auricle. The muscular structure of the heart is every-
where somewhat thinned and atrophied. (Webb’s Patholoqia
Indica, No. 663, p. 16.) J

Chronic Adhesive Pericarditis, with consequent atrophy of the
muscular structure of the heart. 1 J

Ihe left ventricle is held open by a glass rod. The material agglu-
tinating the pericardial surfaces to each other consists of three
alternating layers of white and brown coloured structure. It is

114

DISEASES OF THE HEAET.

[SEKIES VI.

cartilaginous in consistency, and, inclusive of the thickened
pericardium, measures about half an inch in thickness, whilst
the subjacent wall of the ventricle varies only from one-eighth to
one-fourth of an inch in diameter. The carne® column®, chord®
tendine®, and curtains of the mitral valve are also much attenu-
ated. The aortic valves are healthy. The right auricle is kept
open at a point where a portion of the parietal layer is sepaiat-
ed from the visceral lamina. Here the auricular wall is only
one-sixteenth of an inch in diameter, whilst the altered and
thickened external pericardium is fully thrice as thick ’’ (Ewart).

17. Heart, showing the results of old peri- and endo- carditis. There
is a band of firm organized connective tissue uniting the poste-
rior surface of the right ventricle, near its apex, to the paiietal
pericardium. The endocardium of the whole, of the left ventri-
cle is opaque and much thickened. The visceral layer, of the
pericardium over this ventricle is also considerably thickened,
and between them the atrophied muscular tissue of the heart
may be seen, the ventricular wall at the apex being reduced to

18 Heart of a native male patient, aged 20, who died in hospital lrom

empyema and peri-hepatic abscess, &c. There are extensive and
intimate adhesions between the parietal and visceral layers of the
pericardium, especially on the posterior aspects of both ventnc es,
where the organ was firmly bound down to the diaphragm. .

19 Preparation intended to illustrate the earlier effects of adhesive

pericarditis upon the heart. This organ is seen invested by a
very thick leathery pericardium, the visceral and parietal
layers having almost uniformly united, and the pericardia
cavity thereby become obliterated. The muscular wall of the left
ventricle is hypertrophied from the consequent impeded hearts
action. There is no valvular disease.

a native male patient, aged about 30, who died from pneumonia.
Chronic sero-fibrinous Pericarditis. The heart and pericar-
dium are shown in their relative position, the sac of the latter

being opened by a vertical incision anteriorly The pericardium
is seen to be enormously thickened and dilated. Its struc-
ture is quite leathery in consistency. There is an abundant
and extensive deposit of organizing fibrinous exudation cover-
in the heart, and at parts serving to unite the parietal
and visceral layers of the pericardium, so as to sub-divide its
cavity into loculi of varying sizes. These were found occupied
bv an enormous quantity of turbid, opaque, sero-punform fluid.
The heart itself is hypertrophied, and, together with the dis-
tended pericardium, constituted a tumour as large as a melon,
which materially filled the mediastina, the lungs being pushed
back to the posterior and outer sides of the thorax, particularly
the left lung. Taken from a West Indian seaman, aged 28, who

died in hospital. .. . _ .. , ,. *

21 “ Heart of a Sonthali prisoner in the Hazanbagli J ail, who died 01

an®mia following bowel disease. The man was a ‘ klieti at
home, and a gardener in the jail, and therefore not exposed to

From

SERIES VI.]

PERICARDITIS.

115

any of the causes which are said in soldiers to conduce to the
formation of the so-called ‘ soldier’s spot ’ on the heart. There
is a distinct spot, about two-thirds of an inch long1 by a third
of an inch broad, on the front of the right ventricle, about an
inch below the origin of the pulmonary artery, and half an inch
below and to the left of the base of the ventricle. It is freely
movable on the surface of the heart ” (Colles). The patch is
abruptly defined, and can readily be stripped off the surface
of the visceral pericardium. {Presented by Dr. J. M. Coates,
Hazaribagh.)

The heart of a Burmese, who died in hospital, showing a “ white
patch ” on its anterior aspect — the so-called soldier’s “ heart spot.”
The patch is irregularly rounded, rather larger than a rupee, and
consists of a circumscribed thickening of the visceral pericar-
dium covering the anterior surface of the right ventricle.

Heart, with a circumscribed “ white patch” (“ attrition mark ”) of
pericardial thickening on the anterior surface of the right ven-
tricle. It is about the size of a rupee, and surrounded by a
delicate zone of capillary vessels (in the recent state). It shades
off gradually into the surrounding pericardium, and cannot be
stripped without injury to that membrane. Taken from a
native male, aged 30, who died from empyema of the left side
of the thorax. The heart was displaced to the right very con-
siderably. The right ventricle and auricle are much dilated.
Heart, showing a large “ white patch ” covering the greater part
of the anterior surface of the right ventricle. It can be peeled
off with the forceps without injury to the subjacent visceral
pericardium. The right cavities of the heart are dilated.
From a European male (E. H.), aged 48, who died from
apoplexy. (“Medical Post-mortem Records,” Vol. 11 1877
pp. 4G5-G6.) ’ ’

Heart of a native, pierced in three places ‘with wounds, caused
by fractured sternum and ribs
over by the wheel of a buggy, an

ot an hour after the accident. On examination, sixteen hours
after death, there were no external signs of injury to the body.
On removing the integument of the thorax anteriorly, it was
discovered that the sternum was fractured at its centre
transversely, and the third and fourth ribs were broken into
seveial pieces, with their spieula pushed downwards; and,
on lifting the cartilages of the ribs with the sternum, a large
quantity of dark coagulated blood was observed immediately
undei the site of the accident. The pericardium was lacerated
in three points, and also the left ventricle of the heart, even
extending in one place right through the septum ventriculorum
the wounds being filled with coagulated blood. The left lun^
was extremely congested, approaching a dark colour The
nght lung presented nothing worthy of note, except that it

have

The patient was run
ho died within a quarter

was of a red colour at its lower portion, which might nave

^TlWPQndeni-N°nSgl?rity'” (MP Webb- Pelagia Indica,
A 0. lo/9, p. h.) All the wounds are punctured in character.

116

DISEASES OF THE HEAKT.

[series VI.

That on the anterior aspect of the heart seems to have been
caused by the fractured end of a rib perforating the left
ventricle, passing through the septum, near the base of the
heart, and emerging at the larger jagged opening to the right
of the septum, wounding to a slight extent the right ventricle.
The direction of this lacerated wound is at right angles to the
lonsr axis of the heart. The other wound is at the outer

aspect of the left ventricle (deft border of the heart), is nearly
half an inch in length, has smooth edges, and is directed
upwards and inwards, completely perforating the ventricular
wall.

26. “ Heart, showing two ruptures of the right ventricle. One is

situated near the apex, below the ‘ moderator band of King
the other, which is much larger, is close to the inferior or right
margin of the heart, and is only separated from the auriculo-
ventricular opening by the right flap of the tricuspid valve.
The muscular fibre of the heart was healthy, with well-marked
striae. (The right ventricle has been laid open by an incision
through its anterior wall.) The patient, a native labourer,
aged 24, was thrown by a locomotive engine, and his body
violently doubled-up by the fire-box of the engine as it passed
over him. He was killed at once. Besides the rupture of the
heart, there was extensive laceration of the liver, and compound
fracture of one thigh ” (Colles). ( See also Indian Medical
Gazette , Yol. II, p. 45. — Presented by Assistant burgeon
B. W. Switzer, e.r.c.s.i., 12th Bengal Cavalry, Cawnpore.)

27. Buptured Heart. This specimen was received with a note to

the effect that the man, a coolie, “ died suddenly and almost
immediately after a bale of cotton had fallen on the pit of his
stomach, both pericardium and heart being found ruptured on
post-mortem examination.”

The heart exhibits three rents, all in the right ventricle. One runs down
the anterior aspect of the ventricle all along the septum, is two and
a half inches long and half an inch wide ; the second occupies the
space immediately to the right of the apex of this ventricle, the
rupture, commencing about one inch above the outer and lower
border of the ventricle, curves round it, and extends for half an inch
on its posterior aspect. The third is an angular rent, situated close
to the base of the ventricle, its horizontal portion being parallel to
the right auriculo-ventricular orifice, its vertical portion to the
outer border of the ventricle. It measures about one inch in each
direction. All these ruptures have irrregular jagged edges. The
heart itself is somewhat small, covered externally by an unusual
amount of fat, but the muscular structure proves on microscopic
examination to be healthy. ( Presented by Sub- Assistant Surgeon
Gopal Thunder Boy, Howrah.)

28- Heart, showing extensive rupture of the septum ventriculorum.
There is situated, about midway between the apex and base of
the heart, a ragged rent, through which three fingers can be passed,
running somewhat obliquely in a direction from above and in
front, downwards and backwards. On the left ventricular aspect the

8EEIES VI.]

RUPTURE.

117

edges of the rent are comparatively clean, whereas in the right
ventricle they present a very ragged and torn condition, and
extend into the muscular tissue for at least an inch above and
below the actual perforation. 13oth parietal and visceral
layers of the pericardium over the anterior aspect of the heart,
corresponding to the position of the rent in the septum, exhibited
a dark purplish colour, and the cellular tissue just beneath the
visceral layer was ecchvmosed. The pericardial cavity contained
a small amount of sanguineous serum. The right lobe of the liver
(upper margin) was also found ruptured. There was intense
congestion of both lungs, as also very considerable ecchymosis, and
some blood extravasation into the loose cellular tissue of the
anterior mediastinum. Neither the sternum nor any ot the
ribs were fractured.

Taken from a native male, aged 30, who died in hospital thirteen hours
after admission. He was run over by a carriage, two wheels of
which passed over his chest in an oblique direction from left to
right, and was, moreover, trodden upon by the horse.

29- The heart of a native boy, aged 5 years, showing extensive

rupture. “ It is said that the boy was either run over by a
‘ hackery,’ or trampled by one of the bullocks, and died in-
stantaneously. There was no mark of violence visible externally
except two ecchymosed spots — one about the size of a two-anna
piece, situated under the skin in the cellular tissue over the top
of the sternum, and the other about the size of an almond, under
the scalp, over the right parietal eminence. The anterior surface
of the upper lobe of the right lung was ecchymosed. The pericar-
dium was found filled with clotted blood, and the left ventricle
of the heart ruptured from top to bottom. There was no other
injury. None of the ribs were fractured or injured in anyway.”

The rupture is completely through the anterior wall of the left ventricle,
parallel and in close approximation to the septum ventriculorum,
in fact, along the anterior inter-ventricular groove, extending from
the base of the heart, between the root of the aorta and left
appendix auriculae, to the apex, its direction being a little oblique,
from left to right and from above downwards. Corresponding
to this complete rupture of the anterior wall, the posterior wall
of this ventricle has also given way, the visceral pericardium
alone holding together the lacerated parieties in this situation.
( Presented by Hr. Gordon Price, Civil Surgeon, Jessore.)

30- “Heart, with extensive rupture, involving both auricles, the right
ventricle, and the root of the aorta. The patient, a Hindu
“ khalasi,” aged 30, was jammed between two buffers by an engine,
which came up slowly while he was chaining wagons together.
He fell dead on the engine backing. The only injuries sustained,
besides that of the heart, were rupture of the pericardium and
•fracture of the eighth and ninth left ribs. The rupture commences
behind, between tfie auricles, it then winds round the root of
the aorta (in which there is a minute lacerated opening) to the
infundibulum of the pulmonary artery, and obliquely downwards

118

DISEASES OF THE HEART.

[series VI.

and to the right side, through the anterior wall of the right-
ventricle, as far as the “ moderator band of King.” Thence it
runs transversely to the right, as far as the lower margin of the
heart, whence it turns upwards towards the posterior wall of the
right auricle, on which it gradually ceases ; the pericardium and
part of the muscular fibre remaining entire in this part ol the
rupture, and forming a sort of hinge, by which the large flap,
composed of the greater part of the right auricle and the front of
the right ventricle, is attached to the rest of the heart. There is
another laceration, about a quarter of an inch long, in the front
wall of the right ventricle, between the great rupture and the
septum, which does not involve the pericardium. It is marked
by a blue glass rod. The muscular fibre of the heart was not
fatty” (Colles). ( Presented hy Dr. J. MacLeod Cameron, Civil
Surgeon, Monghyr.)

31. “ Spontaneous rupture of the wall of the right ventricle at the

apex, in a native. The heart is very much altered in its external
appearance. The right auricle is exceedingly dilated. The
auriculo-ventricular opening is very large. There appears to be
no proper right ventricle, but this is compensated for by enormous
dilatation of the pulmonary meatus, which admits four fingers,
and has burst in its most dilated portion. This was caused by an
aneurismal formation in the apex of the left ventricle, about the size
of a small fowl’s egg, which has encroached upon the capacity of
the right ventricle.” (Allan Webb, Pathologia Indica, No. 1660,
p. liv.) “ The man was admitted into hospital on the 10th
November 1847 with slight fever, from which he was quite free on
the Ilth. After being discovered on the morning of the 13th in
a state of nearly complete collapse, he emerged with scarcely any
signs of vitality, but lived for nearly 12 hours. The rupture was
nearly longitudinal. The opening at first, when the rupture was
examined, was exceedingly minute internally, but was externally
about eleven lines in length, and the valve-like opening was
partially closed with clots of blood. There was about a pint of
blood in the pericardium, of dark colour, and only slightly
coagulated. There were about two pints of blood in the pos-
terior mediastinum.” (Memorandum by Dr. Ross.)

On examining the right ventricle carefully, it is seen that the septum
just below the pulmonary orifice has undergone partial dilatation,
so as to form another aneurismal pouch, which projects into the
left ventricle, just above the upper margin of the similar dilata-
tion in this ventricle described by Dr Webb. This projection
can be readily seen in the way the preparation has now been put
up. ( Presented hy Dr. Ross of Jessore.)

32- “ Rupture of the right ventricle of the heart of a native. The whole

or<ran is of a lemon-yellow colour, and in an advanced stage of
fatty degeneration. At the point where the wall has given way,
the whole of the muscular tissue is replaced by fat. The open-
ing is jagged, close to the base of the heart and septum,
and measures about an inch in length, this being in the direc-

SEKIES VI.]

IMPACTION OF BULLET.

119

tion of the long axis of the ventricle ” (Ewart). ( Presented by
Dr. Mountjoy.)

33. A very remarkable specimen, showing the lodgment ol a rounded
leaden bullet in the muscular substance of the left ventricle of
the heart of a soldier, who lived for seventy-two days after the
receipt of the injury.

History “ Private Israel Hinton, of Her Majesty’s 80th Regiment,
was wounded in the storming of the Great Pagoda at Rangoon,
on the 14th of April 1852. He was treated in the field hospital
by Dr. Fayrer for upwards of a fortnight, and when apparently
convalescing, transferred to the depot hospital at the Amherst
Sanitarium.” He was here received under the care of Dr. White,
who reports— “The ball had entered about the top of the right
shoulder, taking an oblique direction towards the cavity of
the chest. Blood and air issued from the wound for several
days afterwards. His breathing was difficult, and accompanied
by a short distressing cough and sanguineous expectoration.
There was tumefaction of the left side of the chest.” * *

These symptoms had in a great measure subsided on the admission
of the patient under the care of Dr. White. The cough was then
slight, and there was no blood in the material expectorated. “ There
was some emaciation, small and quick pulse, and clean tongue.
The skin was cool, bowels regular, wound looking healthy, spirits
good, patient expressing every confidence as to his ultimate
recovery. There was dullness over the left side, slight respiratory
murmur only underneath the clavicle. The wound was closed
on the 12th of May. Febrile symptoms then came on every
evening. On the 13tli he stated that he had passed a most
restless night, owing to fearful dyspnoea and coughing, which
were relieved after he had brought up some bloody muco-purulent
expectoration. The recurrences of similar distressing paroxysms
prevailed till the 16th, when his dyspnoea was constant, and he
consequently spent very sleepless and wretched nights. He
remained in this state till the 24th, after which he enjoyed com-
parative ease and respite till the 3rd of June, when the dyspnoea
and bloody expectoration returned with aggravated force. On
the 11th emphysema reappeared in the situation of the original
wound, extending into the axilla and down the left side of the
chest. This was reduced by pressure, but immediately returned
on the withdrawal of the same. He was now greatly depressed
in spirits, pulse small, gradually sinking. On the 14th he
experienced profuse perspiration, and no respiratory murmur
could anywhere be heard in the left side. On the 16th he suffered
from hiccup, was emaciated to a skeleton, and expectorated
purulent matter, untinged with blood. On the 20th he was
manifestly worse. He died on the 24th, having survived 72
days after the reception of the ball in his chest.

Post-mortem examination six hours after death. The body was pale
and frightfully emaciated. The passage of the ball through the
pectoral muscle could not be observed ; but it seemed to have
passed into the thorax between the third and fourth ribs,

120

DISEASES OP THE HEART.

[series VI.

proceeding in its course downwards and inwards. The pleura was
firmly adherent to the left side, forming a cavity which
extended from the first to the seventh ribs, and from the spinal
column to the cartilages of the ribs. This contained about a
pint of pus. The left lung was impervious to air throughout.
A small portion of the cloth of the jacket was lying loosely at
the orifice of a canal situated about the middle of the lung in
its convex aspect. This canal, passing forwards and inwards,
stopped short close to the union of the pulmonary veins, when
all further traces of the passage of the ball were lost. On
raising the heart, however, a hard and firmly impacted substance
was felt at its apex, which, on examination, proved to be the
ball in tbe left ventricle, at its most inferior part, crossed and
re-crossed by the chordae tendineae and carneae columnae, which
secured it firmly in its position. The heart was perfect in every
respect, and the only conclusion that could be arrived at was
that the ball must have perforated one of the left pulmonary
veins, and thus passed into the left auricle, and ultimately into
the left ventricle.” ('Indian Annals of Medical Science, Yol. I,
p. 294.)

Note. — The pulmonary veins have been cut away in the preparation, and it is not
recorded whether any wound in them was discovered. The suggestion
seems, however, to be very improbable ; for, first, any wound of a vessel like
a pulmonary vein must of necessity have been immediately or very quickly
fatal from haemorrhage; secondly, the mitral flaps and their appendages
(chordae tendineae, &c.), which one would expect to have been injured by the
passage of the bullet through the left auriculo-ventricular opening, are
quite healthy-looking and normal ; thirdly, there is evidence of slight lacera-
tion of the muscular tissue around the imbedded bullet on the inner aspect
of the left ventricle, which is not consistent with the view that it merely
dropped into this position. On the other hand, no trace of any wound,
cicatrix, or any other indication of injury to the muscular tissue on the
external aspect of the heart can be found, though very carefully searched
for, and with the aid of microscopical examination of the adherent visceral
pericardium and muscular fibre; but then the heart has been laid open
post-mortem in various directions, and thus any trace of such a lesion may
have been destroyed, or at any rate rendered unrecognizable at this long
period after the date of the injury; while it is also to be remembered that
the patient having survived for 72 days, there was afforded ample time for
the repair of any injury to the muscular substance of the heart. So that,
on the whole, I consider the probabilities are much more in favour of toe
bullet having completely perforated the muscular wall of the ventricle, and
lodged in situ, than as suggested in the text (J. F. P. McC.). ( Presented
by Dr. P. W. White, of the Depot Hospital, Amherst.)

34- “ Inflammation of tbe substance of the heart. There are two

dark patches, indicating the site of inflammation and approach-
ing disintegration of the muscular tissue.” One of these is
situated on the anterior aspect of the heart, near the centre,
and reaches into the septum ; the other is a little higher up
and to the left, involving the muscular structure of the anterior
wall of the left ventricle. No history. (Webb’s Pathologia
Indica , No. 789.)

35* Heart, small and shrunken, with thin, soft, and pale walls, and
in the right ventricle, on the septum and near the root of the
pulmonary artery, exhibiting two or three small, raised, soft

SERIES VI.]

MYO-CARDITIS.

121

nodules, beneath the endocardium. The general muscular
tissue is highly fatty. The fasciculi, under the microscope, are
seen atrophied, brittle, devoid of transverse striae (to great
extent), and freely dotted with dark granules of fat. The
nodules have a different structure. They arc composed of small
nuclei, with the remains of blood-corpuscles, and very delicate
fibrillating tissue ; appear therefore, to be the result of chronic
inflammatory changes. The muscular tissue beneath and around
the nodules is highly fatty and degenerate. The largest nodule
is the size of a small pea, the others like barley-grains. No
history. (Presented by Professor Chuckerbutty )

36 Acute ulcerative peri- and myo-carditis. Both layers of tho

pericardium are highly injected, vascular, and ecchymosed.
A layer of yellowish lymph is seen between their opposed surfaces
on the anterior surface of the heart. The visceral pericardium
near the apex of the left ventricle, for a space about the size of
a rupee, is ulcerated, this condition extending to the subjacent
muscular tissue, which is soft, shreddy, and eroded.

From a case of pyaemia and tetanus (a native male, aged GO), following
a lacerated wound of the foot. (See further “ Surgical Post-
mortem Records,” Vol. I, 1879, pp. 643-44.)

37 Heart, showing (1) acute pericarditis, sero-sanguineous in

character; (2) acute endocarditis (valvular), the affected
(aortic) valves covered with recent vegetations ; and (3) ulcerative
myo-carditis.

The parietal pericardium has been removed. The visceral layer exhibits
great vascularity and ecchymosis, aud was invested, in the recent
state, by a layer of granular lymph, spread uniformly over the
cardiac surface. Six ounces of dark sanguineous serum were
also found in the pericardial cavity. The right and left coronary
valves bear large fibrinous vegetations on their ventricular
aspects, the left flap being further perforated in two situations,
leaving only a thin bridle of valve-tissue between the apertures,
through which a crow-quill would pass easily. The portion of
the endocardial surface situated below these valves— between
them and the left auricle, and immediately above the anterior
flap of the mitral — is acutely inflamed and ulcerated over a space
nearly as large as a rupee. The ulcerative process extends so
deeply as to have almost produced perforation of the auricular
wall in this direction. The left ventricle is dilated ; the mitral
orifice widened, but its valves healthy.

<rom a Mahomedan (male), aged 26, who died in hospital. (“Medical
Post-mortem Records,” Vol. Ill, 1880, pp. 445-46.)

38- Heart covered within and without by small-pox -looking pustules,
probably of pyaemic origin, which are also abundantly developed
upon the aorta and pulmonary artery within and without.
Ihe right auricle shows scarcely any pustules, excepting
one or two large ones upon the appendix auriculae. The outside
ot the right ventricle is free, excepting the meatus pulmonalis,
upon which they are so numerous as to have become confluent
upon the tricuspid valve, where it is joined to the meatus.

122

DISEASES OF THE HEART.

[series VI.

****** The left auricle is free from pustules both within and
without. The left ventricle is very much dilated and covered
with pustules anteriorly , but none corresponding are seen
upon the endocardium. On the contrary, the posterior wall of
the ventricle is entirely free, externally upon the pericardium,
whilst internally the endocardium is loaded with them. The
aorta has a large oval opening in one of its semilunar valves,
most probably from the separation of a pustule, and a large
irregular opening leads from it to a small aneurism, which would
contain a hazelnut, extending between the auricle and ventricle
on the left side. The aorta interiorly presents marks as of
cicatrices from pustules ” Allan Webb. (Vide Patliologia
Indica, No. 1523, p. lii.) No history.

The left ventricle has been opened from behind ; the dilatation
of its cavity is well seen, as also the perforation of the right
semilunar valve. The little aneurism described appears
to be a dilatation of one of the sinuses of Valsalva. It lies
between the aorta and pulmonary artery in the right auriculo-
ventricular groove. It has been filled with a little cotton
wool, and the sac may be seen laid open on the external aspect
of the heart, — the sides separated by a glass rod. The coronary
arteries are not involved in this aneurismal dilatation of the
aorta.

39 The heart of a native male (Hindu), aged 3G, who died from

arsenical poisoning, showing large patches of dark-purplish
blood extravasation beneath the endocardium of the left
ventricle, and principally at the upper part of the septum
ventriculorum. (Presented by Dr. R. Harvey, Civil Surgeon,
24-Pergunnalis, Alipore.)

40 The heart from a case of arsenical poisoning, — a native female,
aged 20, — exhibiting considerable sub-endocardial ecchymosis
of the left ventricle. The septum ventriculorum is chiefly
affected, and presents small patches of a deep-red or port-wine
colour. The muscular tissue here’ is not merely stained, but,
in the fresh state, fluid blood escaped on incising the patches.
There are similar, but smaller and less intense extravasations
beneath the endocardium of the right ventricle, also most
marked at the upper part of the septum.

Examined miscroscopically, the transverse striation of the muscular fibre is found
normal, or hut slightly indistinct in parts as compared with healthy muscle.
Free blood -corpuscles, both coloured and pale, are observed in abundance,
extravasated amidst the fasciculi, and there is a remarkable multiplication
of the connective tissue nuclei of the sarcolemma, as if indicative of com-
mencing irritative chanyes in the muscular fibre itself, i.e. not merely a
localized passive blood-extravasation.

41. c< Extreme atrophy of the heart of a native. The walls and
valves are equally wasted and attenuated to such an extent that
the organ is scarcely half the average size” (Ewart). ( Presented
by Dr. F. Oxley, of Singapore.)

42- Atrophy of the entire heart of a Bengali woman, “ who died
from fever.” ( Presented by Professor Allan Webb.)

SERIES VI.]

ATROPHY.

123

43 “ Atrophy of the heart. The parieties of the organ are of a

pale yellow colour. Both ventricles are opened, exposing attenu-
ated musculi papillares, chordce tendinece , and curtains of mitral
and tricuspid valves ”• (Ewart). ( Presented by Dr. Eatwell, of
Pubna.)

44 Atrophy of the heart in connection with tubercular phthisis of
both lungs. From an adult Hindu woman. “The heart weighs
only three and a half ounces ; its cavities are diminished, and the
wall of the right ventricle greatly thinned. Valves healthy ”
(Colles).

45 A small atrophied heart, weighing only 3f ounces. Its walls are

thin, pale, and soft.

From a native female, aged 38, who died from chronic dysentery, and
in a state of great emaciation. (“ Medical Post-mortem Records,”
Vol. II, 1878, pp. 715-10.)

46- Hypertrophy of the left ventricular walls, consequent upon
obstructive atheromatous thickening of the aortic valves and
coats of the aorta ” (Ewart).

Towards the apex of the ventricle the muscular tissue is from one-and-a-
half to two inches in thickness.

47- Hypertrophy of the left ventricle without commensurate dilata

tion. No history. {Presented by Mr. P. Minas.)

48 Enormous hypertrophy, with but slight dilatation of the heart,
associated with atheromatous disease of the coronary valves
and aorta. The walls of the latter are rigid and thickened from
calcareous changes, and the ascending portion of the arch is
fusiform ly dilated. {Presented by Dr. J. Macpherson.)

49- “ A hypertrophied heart. The cavity of the left ventricle is

exposed. The parieties measure fully an inch in thickness. The
muscular structure is firm and compact. The aortic valves aro
agglutinated together and thickened, leaving an elliptical
opening, held open by a red glass rod. The valves were, in great
measure, competent to prevent much regurgitation during tho
diastole ; but their partial union by organized material rendered
their accurate apposition to the walls of the aorta during the
systole an impossibility, thus opposing an inseparable obstacle
to the transmission of the blood from the ventricle into the aorta.
Hence the compensatory hypertrophy of the muscular structures
oi the left ventricle without dilatation ” (Ewart).

[550- “ Heart of D. N. Robinson, who died in the Medical College
Hospital on the 5th of April 18(54. The left ventricle is consi-
derably hypertrophied. There is no valvular disease, but much
atheromatous degeneration of the arteries was discovered. * *

There was found an old apoplectic clot near the surface of the
posterior part of the right hemisphere. A sac filled with
greenish -coloured fluid— the remains of an apoplectic effusion—
also existed in the right corpus striatum. The arteries of the
circle of Willis were thickened and atheromatous, as also
the coronary arteries, which have been laid open (Ewart)
{Presented by Professor Norman Chevers.)

124

DISEASES OF THE HEART.

[sEBIES VI.

51. A preparation illustrating the relation between granular degenera-

tion of the kidneys (chronic Morbus Brightii) and hypertrophy of
the heart. The hypertrophy affects chiefly the left ventricle, the
muscular wall of which, near the base, is quite an inch and a half
in thickness. The kidneys are contracted, granular at the surface,
and here also exhibiting numerous small serous cysts. . The
aortic valves and lining membrane of the aorta are highly
atheromatous. The abdominal and iliac vessels and the cerebral
arteries were all found similarly diseased. “ The patient, aged
56, was admitted into hospital with a small carbuncle on the
nape of his neck.”

52. Simple hypertrophy of the heart, the valves being healthy. The

muscular wall of the left ventricle measures fully an inch near
the base. This hypertrophy was associated with granular
degeneration of the kidneys.

The visceral pericardium is slightly thickened, and shows the remains
of recent inflammatory deposit (lymph), in the form of shaggy
brownish patches. A few drachms of turbid serum were
found in the pericardial cavity.

The patient, a Hindu, aged 48, was admitted into the hospital foi acute
pericarditis. He died from sudden syncope the day after admis-
sion.

53. Heart showing great hypertrophy of the left ventricle, not asso-

ciated with valvular lesions, but with extremely small, granular,
and contracted kidneys, and illustrative therefore of the connec-
tion which so commonly exists between these diseases.

54. Hypertrophy of the left ventricle of the heart, from a patient who

died in hospital suddenly from serous apoplexy (effusion into the
ventricles of the brain). The kidneys were small, granular, and
hard.

65. Heart showing great hypertrophy without any valvular or aortic
disease. The left ventricle is chiefly affected. Its walls measure
from an inch to an inch and a half in thickness, and the whole
heart weighed 12 ounces. The kidneys were highly granular.
The vessels forming the circle of Willis were atheromatous, and
a small ancurismar tumour (about the size of a pea) was found
developed in connection with the anterior communicating artery.
The brain was soft and cedematous, the lateral and third ven-
tricles filled with serum, and much serous effusion also into the
meshes of the pia mater. From a native female, a prostitute,
aged about 35, who died from chronic Morbus Brightii.
(“ Medical Post-mortem Records,” Vol. I, 1875, pp. 943-44.) _

56 Preparation intended to illustrate the association of chronic

Bright’s disease of the kidneys with hypertrophy of the heart.
The kidneys are seen to be typically granular, contracted, and
atrophied (interstitial nephritis), each weighing only one and
three-fourths of an ounce. The hypertrophy affects chiefly the
left ventricle of the heart, the walls of which are much thickened,
and its cavity somewhat dilated. This organ weighs 16 ounces.

57 Great hypertrophy of the heart with corresponding dilatation of

its cavities, particularly of the left ventricle. The aortic valves

SERIES VI.J

HYPEETEOPHY.

125

and ventricular flap of the mitral are greatly thickened and
covered with “ vegetations.” No history.

58- Hypertrophy with dilatation of the left ventricle. The aortic
valves show considerable thickening, opacity, and puckering from
atheromatous changes, which also involve the ascending portion
of the aorta. ( Presented by Dr Cantor )

59. Enormous hypertrophy, with dilatation of the heart, from a case of
Morbus Brightii. ( Presented by Professor Chuckerbutty.)

60- Great hypertrophy with dilatation of the heart, affecting chiefly
the left ventricle. The organ weighed 16 ounces. The aortic
valves are diseased, thickened, crumpled, their free margins rounded
and opaque. They are altogether incompetent. The whole of
the ascending portion of the arch of the aorta shows marked
atheromatous thickening. The endocardium of the left ventricle,
between the coronary and mitral valves, is rough, opaque, and
over a patch the size of a sixpence, superficially pitted as if from
ulceration. The flaps of the mitral, especially at their attach-
ments to the chordae tendineae, are also abnormally opaque and
thickened. The muscular wall of the left ventricle, near the
base, measures fully an inch in diameter. Taken from a Maho-
metan named Wazzeer. “ On admission into hospital, a double
bruitwas found masking both the cardiac sounds.” ( Presented
by Professor C. E. Francis.)

61- “ Heart, showing enormous dilatation, with hypertrophy of the

left ventricle, calcareous vegetations of the three aortic (sig-
moid) valves, and of the posterior flap of the mitral valve. All
the affected parts are shrivelled and puckered up to about half
their normal size, and are covered with hard, gritty, wart-like
masses, one of which is seen in section in the diseased portion
of the aortic opening. The “ septum of Leutand ” is healthy,
but the adjoining part of the opposite (posterior) flap of the mitral
valve contains a mass of calcareous deposit, the size of a pista-
chio-nut, besides numbers of the warty vegetations before
mentioned. There is dilatation of the root of the aorta. The
pericardium is firmly adherent to the anterior wall and apex
of the heart. A portion of it has been detached and held
apart by black glass rods. The heart, when emptied of clots
weighed 21bs. 3ozs. From the body of Henrv Jackson’
Disease was of eight years’ standing, and of rheumatic origin ”
(Colles). (Presented by Assistant Surgeon A. Vans Best
Presidency General Hospital.)

62- The heart of a European patient, aged 35, who died in the

I residency General Hospital from angina pectoris. The left
ventricle is dilated, and its walls very much hypertrophied
The aortic valves are slightly thickened. The opening of the
coronary arteries are preternaturally high placed; each orifice
is seen very much contracted, the calibre of the vessels dilating
beyond, but no appearance of any degenerative change observed
in them. The ascending portion of the arch presents several
circumscribed spots of atheromatous deposit. The largest of
these oblong in shape, about an inch in length and half an inch

126

DISEASES OF THE HEART.

[series VI.

iii breadtli, is situated at the root of the arch, immediately
above the conjoined insertion of the right and middle coronary
valves. The left auriculo -ventricular opening is wide and
expanded ; the chordae tendineae stretched and thickened ; the
papillary muscles very much hypertrophied. The right side of
the heart shows corresponding hypertrophy with dilatation.
( Presented by Dr. W. J. Palmer.)

63. Heart showing extensive hypertrophy with dilatation. There is

stenosis of both mitral and aortic orifices. The former barely
admitted the tip of the little finger, and the latter is reduced to
a mere slit. Both the coronary and mitral valves are greatly
thickened, contracted, and rigid from calcareous deposit. The
middle aortic llap is ulcerated and fissured on its ventricular
surface. The pericardium is seen universally adherent. The
muscular structure exhibits, on microscopic examination, wide-
spread, fatty metamorphosis.

Taken from a native male patient, aged 27. The heart’s action was
excited ; there were systolic murmurs, — one sharp and distinct at
the apex, the other at base and midsternum, and also at the right
and left second cartilages. There was a history of rheumatism
during childhood.

64, A heart, weighing 2G ounces, and exhibiting enormous dilatation,

with hypertrophy of the left ventricle, the result of disease of the
aorta and aortic valves. The morbid condition of the latter is
very marked. The segments are crumpled, their edges rounded,
irregular, and thickened; the right and middle flaps have partially
coalesced; and altogether the change is such as must have pro-
duced, during life, considerable incompetency, the altered valves
being quite insufficient to close the aortic orifice, and yet, at the
same time, narrowing it. The lining membrane of the aorta
throughout the arch was thickened and atheromatous, here and
there slightly calcareous ; the ascending portion ( see prepara-
tion) dilated. The mitral valves are much stretched, but not
otherwise diseased. The left auriculo-ventricular opening admits
five fingers, the left auricle is dilated, and so also are the cavities
on the right side, but to a much less extent as compared with the
left. The left ventricle was found quite uncontracted. Its walls
measure fully an inch in thickness. Both coronary arteries arise
together in the sinus of Valsalva behind the middle coronary
valve ; their orifices are much contracted from the atheromatous
condition of the aortic lining membrane. Taken from a Malay, a
seaman, aged 35, who died in hospital.

65- Enormous dilatation of both left and right cavities of the heart,

with disproportionate hypertrophy of the muscular structure.
The organ is three to four times its normal size. No history.
(. Presented by Mr. Hannah.)

66- Great dilatation of the left ventricle without corresponding hyper-

trophy. The columnse earn® are dissected out so as to form
wide meshes : the whole of the endocardium abnornally thick
and opaque. Tlie aortic valves show chronic inflammatory
changes, arc greatly thickened and rounded off at their free

SEKIES VI.]

DILATATION.

127

68.

69.

70.

71.

margins, much contracted and shortened, and must have been
very “ incompetent. ” The mitral flaps are also diseased. No
history.

General dilatation of the heart without hypertrophy, in fact,
the muscular structure is atrophied. The muscular columns
in the interior of the left ventricle (exposed) are seen to be
wasted. The aortic valves are greatly diseased, and no doubt
this was the primary cause of this morbid condition. The
valves are much thickened and opaque, the two anterior flaps
coherent, so that, viewed from below, the aortic orifice seems to
be guarded by two valves only, and is reduced to a mere chink,
half an inch in length and a few lines wide. The “ obstruction”
thus produced must have been very great, and although at first
leading probably to hypertrophy, has ended in dilatation of the left
ventricle and auricle. The right cavities are also dilated.
“ Taken from a native, whose liver, lungs, and brain manifested
apoplectic effusions of blood.” (Webb’s Pathologia Indica
No. 1422, p. lii.)

The heart of an East Indian patient (male), aged 27, “who died in
hospital from haemoptysis (pulmonary apoplexy).” The oroan is
large, the left ventricle dilated. Both aortic and mitral valves
are diseased. The former are thickened, partially conjoined, and
the central and right flaps are, in addition, ulcerated. The mitral
orifice is much constricted, both laminae of the mitral thickened
and opaque, as also are their chordae tendineae. The auricular
aspect of the mitral ring (orifice) is at one point calcified.
The left auricle is dilated, its endocardium throughout thickened
and so also is the lining membrane of the left ventricle'
especially that portion just beneath the aortic orifice, where it
forms two or three valve-like folds.

The heart (with its pericardium reflected) of a confirmed opium-
eater, a native female, aged 60, showing great dilatation of the
ventricular cavities, stretching and thinning of the valves
atrophy of the muscular walls, and diffuse molecular fattv
degeneration of the muscular fasciculi, as exhibited on micro-
scopic examination.

The heart of a native woman, aged 35, admitted with general
dropsy. The specimen shows (1) general dilatation of the right
side ot the heart, and of the left auricle ; (2) thickening, harden-
ing, and button-hole-like contraction of the mitral valves, so
that they form a transverse slit which scarcely admits the tip of
the little finger. The chordae tendineae are much fore-shortened
m fact, have almost disappeared, the apices of the papillary
muscles being brought into direct contact with the rigid
margins of the valve. The aortic valves are also slio-htlv
thickened. °

Heart showing immense dilatation of the left ventricle, with some
(but not much) hypertrophy of the muscular walls The
endocardium has throughout an opaque, thickened appearance

loLr. rrtl° “f? “itral valvcs 1>resent sirailar changes!
immediately above the coronary arteries the lining membrane

128

DISEASES OF THE HEAET.

[series VI. |

of the aorta exhibits an irregular-shapecl, but distinctly marked,
slightly raised patch of thickening, which, in the fresh condition,
was highly vascular and ecchymosed. This patch of inflamma-
tion (acute endo-arteritis) was apparently of recent origin. The
pericardial sac contained about four ounces of straw-coloured
serum. The parietal and visceral layers were both abnormally
vascular, and spots of sub-pericardial ecChymosis were observed
on the posterior aspect of the left ventricle, near the inter-ven-
tricular groove. The specimen was taken from John Fernandez,
a Portuguese seaman, aged 29 years. In the late .cyclone in the
Bay of Bengal (1872), his ship foundered off Madras, but he
managed to save himself by clinging on to a hencoop. He
continued to float about, thus supported, for five days and nights
(from the 3rd to the 8th May) without any food or fresh water.
On the 8th May he was picked up by a steamer, and landed in
Calcutta on the 13th. He now began to experience severe pain
in the chest, and, this becoming daily aggravated, applied at
the hospital, and was admitted on the 18th May. His condition
on admission was as follows : Complains of severe pain at the
epigastric notch. Is much depressed. Has a short, dry cough,
and the breathing is hurried. The legs and feet are oedematous.
Pulse rapid, soft, compressible, 120. The area of cardiac dulness
is found increased, and the heart’s sounds distant. A systolic
bruit is distinctly heard at the apex and mid-sternum, disappear-
ing towards the axilla and aortic cartilage. There is also
dulness with pneumonic crepitation at the base of the right lung.
He died unrelieved the following day.

72. Heart showing great dilatation with some hypertrophy of the right

ventricle. The valves on both sides of the heart are healthy.
The aorta was highly atheromatous,— a portion is preserved with
the specimen. Taken from a patient who had for several years
suffered from chronic bronchitis with pulmonary emphysema.

73. Dilatation of the right auricle and ventricle of the heart, with

slight hypertrophy of the muscular wall of the latter. The
auriculo-ventricular opening admits four fingers. The tricuspid
valves are stretched.

From a native male, aged 50, who died from chronic bronchitis with
much emphysema of both lungs.

74. Heart showing great hypertrophy of the left ventricle, and a

dilated condition of the right chambers. The aortic and mitral
valves and the lining membrane of the left ventricle are abnor-
mally opaque, slightly thickened, and the coronary valves
insufficient. The aorta is markedly atheromatous, this condition
extending throughout the thoracic and abdominal aorta, and
into the° common iliacs. The right side of the heart is exposed.
The tricuspid and pulmonary valves are normal, the latter
perhaps a little thinned and stretched, and the pulmonary orifice
slightly dilated. The foramen ovale ( see preparation) is patent,
or rather, there appears to be a perforation or imperfect closure
of this orifice, — a rounded opening which admits the tip of the
little finger, existing at the upper part of the membrane which

SERIES VI.]

HYPERTROPHY WITH DILATATION.

129

75.

76.

usually fills in this foramen. The margins of the perforation or
opening are hard ar.d rounded, appear to be thickened and
atheromatous. The heart weighs 16 ounces.

From a native female, aged 38, who died in hospital. There was no
history obtainable of either rheumatism or syphilis, but the
kidneys were highly contracted and granular. ( See further,
“ Medical Post-mortem Records,” Vol. II, 1877, pp. 457-58.)

An hypertrophied heart with dilatation especially of the right
cavities. The aortic and mitral valves are thickened and opaque,
particularly the latter. The left auriculo-ventricular opening is
much contracted, admitting only one finger (mitral stenosis).
Both anterior and posterior llaps and their chordae tendineae are
rigid. The left auricle expanded. There is complete adhesion
of the opposed layers of the pericardium, and consequent
obliteration of the pericardial cavity. Weight of the heart
14^ ounces. From a Chinaman, aged 34, who died in hospital.
(“Medical Post-mortem Records,” Vol. II, 1877, pp. 501-502.)
Heart showing dilatation with hypertrophy of the right auricle
and ventricle. The auriculo-ventricular orifice admits five
fingers. There is no disease of the left chambers. This condition
of the heart was associated with great emphysema and pigmen-
tation of the lungs and chronic bronchitis, the result probably
of prolonged “ ganjah-smoking.” From an East Indian (male)
A. R, aged 25, who died in hospital. (“Medical Post -
mortem Records,” Vol. II, 1878, pp. 683-84.)

Hypertrophic dilatation of the right side of the heart, particularly
of the right ventricle, the result of chronic asthma and great
emphysema of the lungs. From a European male patient, aged
41, by occupation an engineer, who died in hospital.

Great hypertrophy with dilatation of the right cavities of the
heart (tricuspid regurgitation). The auriculo-ventricular orifice
admits six fingers. The muscular wall of the left ventricle
is normal, and the mitral and aortic valves healthy. There was
general, evidently long-standing bronchitis of both lungs. The
liver was cirrhotic and “ nutmeggy.” From a native male,
aged about 25, who died in hospital. ( See further, “ Medical
1 ost -mortem Records,” Vol. Ill, 1S79, pp. 553-54.)

Heart showing considerable dilatation with hypertrophy of the
right chambers, associated with chronic bronchitis and emphy-
sema of the lungs, and a “ nutmeggy ” condition of the liver,
the muscular tissue, just beneath the endocardium on the
anterior wall of the right ventricle, exhibits zigzag lines,
small dots, and patches of yellowish discoloration "from fattv
metamorphosis. The heart weighs 12£ ounces. From a native
male, aged 40. (“Medical Post-mortem Records,” Vol IIT
t-L880, pp. 555-56.) ‘ ;

Aneurism of the Heart.” The preparation exhibits a very
remarkable double pouch-like dilatation of the left ventricle
near its apex. The muscular wall is thinned in this situation’
Ihe pouches are lined by thickened and opaque endocardium,
mie over their external aspects the pericardium is similarly

78.

79.

i80.

130

DISEASES OF THE HEART.

[SEBIES VI.

thickened. The mitral valves appear to he healthy, the aortic
slightly thickened, the aorta rough and atheromatous. ( Presented
by Professor C. 0. Woodford.)

81. “ Aneurism of the left ventricle, with disease of mitral valves.

The posterior flap of .the mitral is puckered up, and converted
into an unyielding horizontal septum ; the mitral orifice is reduced
to a mere concentric slit, three-fourths of an inch long. The
auricular surface of the diseased flap is somewhat roughened,
and the auricle itself is dilated. From the angle of junction
between the posterior wall of the left ventricle and the septem
ventriculorum an opening, large enough to admit the forefinger,
leads to an aneurismal sac, the size of a billiard ball, situated
below the inferior and left border of the heart. Its outer and
lower wall (which has been opened in two places) is about one-
fifteentli of an inch thick, and is formed only of pericardium
and fibrous tissue. The right ventricle is healthy. There was
an obscure history of syphilis in the case ” (Colles).

82- “Extensive atheromatous degeneration of the ascending aorta,

with incipient dilatation. The apex of the heart (left ventricle)
is adherent to the pericardium, and the ventricle itself is so much
elongated as to form the entire apex of the heart, to the com-
plete exclusion of the right ventricle, which falls far short of it.
The apex of the left ventricle forms an aneurismal cavity, about
the size of a walnut, with thinned walls, and containing an old
laminated coagulum, now lying loose in the cavity, but which
was originally adherent to its walls” (Colies).

83- True aneurism of the heart. The left ventricle is displayed.

There is a circumscribed dilatation of its walls sufficiently large
to hold an orange. This is situated at the apex, reaching
further posteriorly than anteriorly. It is partially filled by
firm, laminated coagulum. The muscular tissue constituting the
sac is thin and atrophied, but strengthened on the exterior by
abnormal thickening of the visceral pericardium. The heart
altogether, and especially the left ventricle, is much dilated,
but the specific and circumscribed dilatation of the apex to
form the aneurism is quite distinct from the general expansion of
the ventricular cavity. Death is said to have occurred quite
suddenly, just after a meal. ( Presented by Dr. Cleghorn, Offici-
ating Civil Surgeon, Cawnpore.)

84. Heart showing aneurismal dilatation or pouching of the left
ventricle near the apex. The sac or pouch is rather larger than
a walnut, is lined by thickened endocardium, and in the fresh
state was found ’ partially filled with laminated fibrinous
coagulum. The muscular tissue of the ventricle forming its
anterior and inferior walls is much thinned, but the pericardium
over the sac is thickened, and its opposed layers adherent for
some distance around the same. The left ventricle generally
is dilated. “No history of the case could be obtained, save that
the man died suddenly.” ( Presented by Dr. C. 0. Woodford,
Police Surgeon.)

SEKIES VI.]

ANEUKISMAL DILATATION.

131

86.

Heart with (1) mitral stenosis; (2) aneurism of the left ventri-
cle; and (3) ante-mortem fibrinous vegetations in both right and
left auricles. The heart is square-shaped, the apex formed by
the right ventricle. This cavity is considerably dilated, and
at the same time its muscular walls are hypertrophied. The
right auricle is also dilated. A series of firm, rounded, or
tongue-shaped fibrinous concretions are seen wedged into the
intermuscular spaces, especially in the appendix. They are
laminated and solid, or (the larger ones) hollow, and pulpy at
the centre. The left auriculo-ventricular opening is greatly
contracted, so much so as to admit with difficulty the tip of
the little finger. On the auricular aspect a fringe of recent fibri-
nous deposit was found. The mitral flaps are exceedingly
thickened and drawn together ; their cordm tendinea? fore-
shortened. and matted together. The endocardium lining the
left ventricle generally is thickened and opaque. Towards the
base of the heart (posterior wall) the muscular tissue of this
ventricle is hollowed out so as to form a sacculated dilatation,
the size of a nutmeg, directed backwards and to the left. Its
anterior wall is situated just behind the posterior mitral flap.
Its inner surface is lined throughout by greatly thickened,
fibrous-looking endocardium. There is thus great mitral steno-
sis, with active dilatation (aneurismal) of the left ventricle. The
muscular wall of this cavity generally is dilated, not hyper-
trophied, at the apex indeed, a good deal thinned. From an
East Indian, Peter N., aged 25, who died in hospital. (See
further, “ Medical Post-mortem Records,” Vol. II 1S77 no

Heart showing an aneurismal dilatation situated in the substance
of the wall of the left ventricle, and communicating by a small
circular opening with the ventricular cavity. From a native
woman, aged about 40 years. “She was found dead in the
stieet, and picked up by the police. On 'post-mortem examina-
tion, the vessels of the brain were found highly congested, and
there was a large quantity of blood extravasated over its surface.”
ihe left ventricle of the heart is much dilated, and the lining
endocardium throughout thickened and opaque, but the valvular
structures are not specially involved ; in fact, the aortic valves
are almost normal. In the anterior wall of the ventricle, about
midway between the base and apex, there is an aneurism-like
pouching of the same, sacculated in character, about the size of a
pigeon egg. It was found filled with soft coagulum, but imme-
diately fined by laminated decolourized fibrin. At this spot on
the outer aspect of the heart, the pericardium is seen greatly
thickened and opaque, covered by a patch of organized “ false
membrane. The fundus of the pouch is formed principally bv
tins thickened pericardium, the muscular tissue of the heart
being quite wanting here, and much atrophied in the rest of the
pouch. Situated a little to the outer side of the latter, is another
shallower, but otherwise similar, circumscribed dilatation of the
anterior ventricular wall, lined by greatly thickened, milkv-

132 DISEASES OF THE HEART. [series vi.

white endocardium. ( Presented by Dr. S. C. Mackenzie, Police
Surgeon.)

87 Heart showing an excessive deposit of fat on the external surface,
most plentiful at the base and along the course of distribution of
the coronary arteries. The muscular tissue is atrophied, and
exhibits, in the deeper strata, extensive fatty metamorphosis.
( Presentedby Professor Allan Webb.)

88- “ Heart of a patient, who died after the removal of a scrotal tumour.

There is excessive deposition of adipose tissue on the external
surface of the organ, and fatty degeneration of the walls and
carnese column® of both ventricles” (’Ewart).

89- The heart of a native male patient, aged 24, who died in hospital.

There is intimate and longstanding adhesion of the two layers
of the pericardium, and much fatty infiltration of the organized
tissue between them. The whole organ is much enlarged, and its
walls greatly thickened, chiefly in consequence of the enormous
development of adipose tissue in connection with the latter. In
the fresh state, the heart weighed 33 ounces, and measured seven
inches in length and five in breadth. The muscular tissue of
the heart is pale and fatty, and blended as it were with the
thickened layers of pericardium, any line of demarcation between
these structures being for the most part absent. On incising the
walls of the ventricles (as has been done in the preparation), they
are seen to be here and there embossed with smooth, oval-shaped,
ill-defined nodules or flattened masses. These exhibit, under the
microscope, scarcely any trace of muscular fibre, consisting princi-
pally (and some entirely) of highly fatty fibro -cellular tissue.
The ventricular cavities are dilated.

90. The heart of a European, aged 08, who died from “ senile debi-
lity.” The organ is loaded with fat externally ; so great is this
on the right side, that the muscular wall of the ventricle is
reduced to about three or four lines in thickness. The whole of the
endocardium, i.e. of both ventricles, and that investing the valves
is hazy or milky in appearance from fatty changes. The mitral
flaps are thick and atheromatous. The coronary valves in a
similar condition, coherent at their margins, and the endocardium
just below the right valve distinctly calcareous. The ascending
aorta exhibits marked fatty, atheromatous, and calcareous
degeneration.

91. Marked fatty degeneration of the heart. From a European, aged

22, a leper, who died in hospital. The change is not uniform.
It is most distinct in the left ventricle, along the musculi papil-
lares and septum ventriculorum. These parts are seen to present
hazy, zigzag lines of pale-ochre colour, just beneath the endocar-
dium. Here the muscular fasciculi are especially altered,— soft
and brittle, filled with small, dark, fatty granules, which replace
more or less completely the sarcous strise. In parts the fibre
seems to be completely destroyed, oil granules and globules being
visible, external to the sarcolemma as well as within it. (See fur-
ther, “Medical P ost-mortem Records,” Yol. I, 1875, p. 766.)

SEBIES VI. J

FATTY DEGENERATION.

133

92 A heart somewhat small and shrunken, and showing streaky,
linear, wavy, pale-buff-coloured spots and patches, irregularly
distributed, just beneath the endocardium of the left ventricle.
In these situations the muscular tissue is very soft and friable,
and under the microscope exhibits marked fatty degeneration
(metamorphosis). The fasciculi are pale, their strife indistinct or
altogether absent, and fine granular or molecular fat takes the
place of the sarcous elements within the sarcolemma. Taken
from a native woman, aged 30, who died from exhaustion due to
haemorrhage after abortion. All the organs of the body were pale
and anaemic. (“Obstetric Post-mortem Records,” Vol. I, 1876,
pp. 247-48.)

93. The heart of a native boy, aged 12, who died from malarial

anaemia and exhaustion. The organ is pale and anaemic, and
shows much streaky mottling of the left ventricle, due to fatty
metamorphosis of the muscular structure. This, in parts, is very
advanced (as seen under the microscope), little or no trace of
striped fibre being visible, nothing but the sarcolemma sheath
filled with dark dots, granules, and globules of fat.

The liver was highly fatty and pigmented ; the spleen enlarged and
dark.

94. Fatty degeneration (metamorphosis) of the muscular structure

of the heart, affecting chiefly the right ventricle, and con-
sisting of yellowish opaque dots, streaks, and patches situated
just beneath endocardium. (Some of these are indicated in
the preparation by means of small bristles passed through
them.) The endocardium covering these spots shows, on
microscopic examination, fatty infiltration of its epithelial
cells, and the muscular fasciculi exhibit varying degrees of
atrophy and fatty metamorphosis : — the striae obscure, fibres
attenuated, dotted, granular ; in parts, almost entirely replaced
by molecular fat.

From a native female, aged 25, who died from cholera. (“ Medical
j Post-mortem Records,” Vol. II, 1878, pp. 987-88.)

95. Fibroid induration of the heart: a specimen received from

the dissecting-room. The left ventricle is slightly hypertrophied.
The pericardium is throughout thickened, and especially over
the anterior aspect of the left ventricle. This part on
section reveals a dirty white or yellowish appearance of a
portion of the anterior muscular wall, an inch and a half in
length, and extending from the opaque pericardium to within
a line or two of the endocardium. The latter is hazy or
milky-looking throughout the ventricle, and the aortic valves
and lining membrane of the aorta present the same conditions.
A similar patch of yellowish colour is found in the right
ventricle, occupying the upper half of the septum ventricu-
lorum ; is about the size of an eight-anna piece, shades off*
at the margins into healthy-looking muscle, and extends into
the substance of tne septum for about three lines. The
muscular tissue of the heart at both these discoloured portions
cuts more firmly, is more resistant than normal, and the

134

DISEASES OF THE HEART.

[series VI.

section presents a fibrous appearance. This is confirmed on
microscopical examination, — the muscular fasciculi at these
spots being separated by numerous small, round cells, distribut-
ed specially thickly round the small blood-vessels, and under-
going everywhere transformation into delicate fibro-elastic
tissue, while the muscular fibre itself is in a state of fatty
metamorphosis.

96- “Heart of a native woman, aged 45 years, a beggar, who died
in hospital after eight months’ illness, showing subacute
endocarditis affecting the left ventricle, also thickening of the
mitral and tricuspid curtains. The organized deposit, which
is mainly of old standing — though some of it is clearly
recent — is situated underneath the lining membrane of the
ventricle. Isolated deposits of the same character, both old
and recent, were seen in the right auricle. There were also
found, after death, inflammatory hydro-pericardium, congestion
and oedema of the lungs, bronchitis, hydrothorax, extreme
cirrhosis of the liver, and general anasarca” (Ew-art).

The whole organ is remarkably firm and rigid. Examined minutely,
1st, the visceral pericardium is greatly thickened — quite three
to four lines in parts, — and, under the microscope, exhibits a large
development of fibro-elastic tissue. In parts, groups of small,
round, germinal cells are seen, as if from recent proliferation,
and these are aggregated principally in the neighbourhood of the
minute blood-vessels. The greater portion of the change,
however, is of longstanding, the connective tissue being well
formed, and extending from the thickened pericardium into the
muscular structure, so as in many instances to reach within a
line of the endocardium. 2nd, the endocardial membrane
exhibits similar changes, except that no recent cell proliferation
can anywhere be detected. The membrane is greatly thickened,
its deeper layers multiplied, and the connective tissue . growth also
dips into the muscular tissue, separating the fasciculi into isolated
bundles, and inducing fatty metamorphosis of the . sarcous
elements from direct interference with nutrition. This is an
example therefore of true interstitial carditis, and in its progress
and results closely allied, apparently, to the “ cirrhotic” process
in the liver, which was also found in this patient.

97 This preparation exhibits the morbid anatomy of acute, pericar-
ditis J affecting a heart already chronically diseased, i.e. in a
state of fibroid induration. The pericarditis is recent, both
parietal and visceral layers being invested with soft, granular,
and flaky lymph. On incising the heart’s walls, however, a
very hard and resistant condition of portions of the muscular
tissme is found, especially of that of the left ventricle. Here,
irregularly circumscribed patches or broad tracts cf the muscular
substance (including, in most instances, nearly the whole thick-
ness of the parieties) are seen of a dull-white colour, and of
fibroid appearance on section, this new tissue replacing the
muscular fasciculi in these situations. The endocardium is also
opaque and thick over the fibroid patches. The muscular papillae

SERIES VI.]

CARCINOMA.

135

and chordte tendineae of the left ventricle are much atrophied,
but there appears to be no disease of the valvular structures.
On microscopical examination, thin sections of this altered
heart tissue exhibit in parts a very abundant small cell, growth —
the cells small, round, and with single nuclei, — in size about
that of white blood-cells. These are associated with a delicate
fibro-elastic tissue, which forms a kind of irregular reticulum.
In other parts the cell growth is scanty, whereas the fibroid
tissue is abundant, replacing altogether the muscular fasciculi,
which are pushed aside, compressed, broken up into small frag-
ments, and very generally in an advanced stage of fatty
metamorphosis. In parts, again, the change is still more re-
markable, the fibroid tissue enclosing much fat in its meshes,
and thus constituting a firm adipose tissue, to the almost entire
exclusion and replacement of both nuclei and muscular fibre.

The central or sub-endocardial portions of the muscular wall are chiefly
affected, the morbid condition apparently advancing from here
towards -the periphery. The pericardium even, in many spots,
is reached ; but generally a thin layer of muscular tissue — in a
state of greater or less fatty metamorphosis — still intervenes
between it and the fibroid growth. “ From a phthisical
patient.” ( Presented by Dr. Green, of Howrah.)

98. Heart showing a large, dendritic, ante-mortem , fibrinous vegeta-

tion in the right ventricle, attached chiefly to, and associated
with, a cancerous deposit in the anterior wall of the same, near
the apex. From a case of enkephaloid carcinoma of the testicle,
with secondary deposits in the lungs, liver, &c.— A European male’
aged 43. ’

The large mass _ presents a beautifully villous or dendritic appearance.
The base is firm, the surface broken up into tufts of various sizes,
and these surmounted by a series of minute grape-like, grouped
granulations, the majority strung in lines or rows like white
beads. Examined microscopically, the whole mass of vegetating
material is undoubtedly ante-mortem. The little bead-like growths
(superficial portion) are composed of organized fibrin, — a cyst-like
wall or sac filled with molecular and granular fat, and albuminous
debris. Longitudinal sections through the deeper portions (base)
show advanced organization of the fibrin,— blood-vessels, and
young connective tissue rapidly developing, and in the lowest strata
epithelial cells are found in clusters, surrounded by small, round
actively growing cells. The appearances therefore imply a
primary infiltration of the sub-endocardial tissue with cancer-cells
(germs), with subsequent deposit of fibrin, and advanced organi-
zation of the latter. {See further, “Surgical Post-mortem
Records,” Vol. I, 1875, pp. 237-38.)

99. Heart irom a case of diffuse melanosis,— an East Indian male
aged 44. Numerous small pigmentary deposits, of a deep black
colour and soft consistency, are seen situated both at the surface
beneath the visceral pericardium, and also beneath the endo-
cardium lining the cavities of the heart. These vary in size from
a pins head to a pea, and structurally are carcinomatous

136

DISEASES OF THE HEART.

[series VI.

(enkephaloid). In the preparation, their positions are indicated
by pins. Similar deposits were found in the liver, kidneys, brain,
bones, &c. ( See further, “ Medical Post-mortem Records,” Vol. I,

1S73, p. 16.) . , , .

100- The heart of a native (male) aged about 40, who died suddenly.
The right cavities are healthy, the left diseased. I lie left
ventricle is dilated, and its walls irregularly thickened, the
latter not being due to muscular hypertrophy, but. to the
presence of nodular growths beneath the endocardium, displacing
the muscular structure, and projecting into the ventricular
cavity One of the largest of these occupies the upper third
of the septum ventriculorum. Another smaller nodule is situated
lower down, near the apex. Besides the nodular new growth,
there is more diffuse sub-endocardial infiltration, of the same
character, involving the lower papillae of the mitral valve, and
the posterior two-thirds of the mitral orifice. At the outer
extremity of this orifice there is a circumscribed dilatation of
the ventricular wall,— a small aneurismal pouch, about the size of
nutmeo-,— and studding the auricular surface of this orifice (mitral)
are two nodular growths, one the size of a small hazelnut,
the other of a pea. All these growths and infiltrations have a
pale pinkish-white appearance, are moderately firm in consistency,
and when thin sections taken from them are placed under the
microscope, are seen to consist of small round cells and nuclei,
undergoing in parts, transformation into spindle-celled and
immature connective tissue ; in others, degenerating, becoming
granular and amorphous in small foci or masses Ihe whole of
one of the larger nodules consists of this kind of material, and is
apparently built up of a series of smaller nodules. Uiey
completely replace the muscular tissue. In the infiltrations
where muscular fibre still remains, it is found atrophied, -the
fasciculi small, their stria indistinct, and the sarcous tissue
granular and fatty. There are a few small b ood-vessels in the
nodular growths. The arteries have their walls thickened and
are prominent from the presence of an abnormally abundant
nuclear growth in their immediate vicinity. On the whole, the
structure of both nodules and infiltrations closely conforms to
that of gummatous growths, and although the history of the
case is wanting, yet there seems to be every probability of
this beiim the real nature of the morbid alterations affecting the
cardiac walls. The pericardium on the outer and anterior
aspect of the left ventricle, opposite the largest nodule, is great )
thickened, and probably the visceral and parietal layers were here
coherent. The muscular tissue of the ventricle in this situation
•s reduced to a fourth of an inch or less in thickness. {Presented

lu Dr. Mackenzie, Police Surgeon.) . . ,

1 m ‘‘The heart and great blood-vessels, showing hypertrophy with
10L dilatation of the left ventricle, and calcareous degeneration of
th* valves and the aorta ” (Ewart). The aortic valves and
the portion of the aorta immediately above them are the most
diseased situations. The valves are greatly thickened, hard,

semes vi.] LACERATION AND THICKENING OF VALVES. 137

firm, and calcareous at their aortic insertions, their opposed
surfaces being here coherent and ulcerated. The central coronary
valve is extensively lacerated, the torn segments covered by a
thick deposit of “vegetations,” hanging loose in the ventricular
cavity. The inner surface of the aorta is greatly thickened and
roughened, with large calcareous plates lying exposed in its
walls. These changes are most marked in the ascending portion,
but extend throughout the arch.

102. Acute valvular endocarditis. Both mitral and aortic valves
are affected. The free margins of the former are covered with
fibrinous warty vegetations ; several of the chordae tendineae
have been torn through. The anterior flap is much thickened,
and is ulcerated on its ventricular aspect. The aortic valves are
a little opaque and crumpled. The endocardium of the left
ventricle generally, but especially over the papillary muscles of
the mitral valve, is milky-white. The ventricle, as a whole, is
dilated. From an Armenian (male) patient, aged 20, admitted
with right hemiplegia, and in whom, on post-mortem examination,
a large blood clot was found in the left middle cerebral lobe,
and haemorrhagic infractions in the spleen, pancreas, and kidney,
all probably embolic in origin.

103. Great thickening and opacity of the endocardium lining the left
auricle, particularly around the auriculo-ventricular opening.
Both flaps of the mitral valve are also extensively diseased,
very hard and firm, iu parts absolutely calcareous, their margins
thickened, rounded, and rigid, the chordae tendineae fore-short-
ened, so that the muscular papillae almost touch the valve
margins. The mitral orifice is reduced to about a third of its
normal size. The left auricle greatly dilated. No history.

104. “ Button-hole constriction ” of the mitral valve. The margin
of the coalesced flaps is rounded, thick, and rigid, and an opening,
only a little larger than a crow-quill, is left between them. The
chordae tendineae are much thickened and fore-shortened. Th&
aortic and tricuspid valves are slightly thickened and opaque.
The right cavities of the heart are greatly dilated, and the left
auricle is also in a state of hypertrophic dilatation.

The patient died from general anasarca, including “ hydro-pericarditis ”
and “ hydro-thorax. ” ( Pathologia Indica, No. GIO, p. 17.)

105. Chronic inflammation (atheromatous) of the mitral valves, with
ulceration and calcareous infiltration of the thickened tissues at
the left auriculo-ventricular opening. The latter is reduced
to a mere slit, the upper or ventricular portion of which exhibits
ulceration and calcareous deposition. The muscular papillae of
the mitral apparatus are matted together, and are united directly
to the margins of the diseased valves, i. e. without the interven-
tion of chordae tendineae. The valves on the right side of the
heart were found healthy, but the right chambers greatly
dilated.

106. “ Button-hole mitral constriction. The orifice will scarcely admit
more than a common pencil ” (Ewart). The thickening, contrac-
tion, and almost obliteration of the chordae tendineae are well

138

DISEASES OF THE HEAET.

[series VI.

seen, as also the narrow and elliptical character of the contracted
mitral orifice. On the right side of the heart the tricuspid flaps
and appendages are abnormally opaque and thickened. No
history. ( Presented by Professor Edward Goodeve.)

107. “ Button-hole constriction of the mitral orifice. The opening
is a mere slit. From a native female, 25 years of age, who
died suddenly ” (Ewart). ( Presented by Professor Norman
Chevers.)

108. Heart and aorta, showing (1) great thickening, rigidity, and
cohesion of the aortic valves, which, moreover, are ulcerated and
partially calcified on their ventricular aspects ; (2) atheromatous
degeneration of the arch of the aorta; and (3) thickening,
opacity, and great contraction of the mitral valves, with much
narrowing of the mitral orifice. No history.

109. A section through the aorta and left ventricle, just above and
below the coronary valves, to show the very extensively dis-
eased condition of the latter. They are hard, firm, rough,
nodulated and coherent, thus reducing the aortic orifice to a
triangular rigid opening, which scarcely admits the tip of the
little° finger. The opposed and free margins of the valves, and
the lining membrane of the sinuses of Valsalva exhibit, in
addition, considerable calcareous infiltration. (Webb’s Pathologia
Indica, No. 118, p. 2 )

110. “ Heart of a European female, who suffered from regurgitant
disease of the aortic valves. These are somewhat thickened,
rigid, shallow, contracted, and one is quite incompetent to
prevent the reflux of blood during the diastole. Ihe upper
margin of another shows tendency to retroversion. There is,
consequently, a dilated and hypertrophied left ventricle. The
curtains and muscular columns of the mitral are also thickened,
but efficient. The ascending aorta is slightly dilated, and
this, as well as the arch and ascending portion, are partially
atheromatous. About an inch above the faultiest valve, there is a
small aneurismal pouch, about the size of a nut, which is
advancing towards the descending cava, at its termination in the
auricle. °The exact point where the sac impinged upon the
descending cava is indicated in the back view of the preparation
by two glas^ rods crossing each other. ***** In this case
there was a double bruit over the aortic valves. It would have
been doubtful whether this depended upon aneurism of the
ascending arch, or upon not excessive regurgitant disease of the
aortic valves. The moderate “ water-hammer ” character of
the pulse decided the point. (Ewart.) ( Presented by Professor

Norman Chevers.) .

111. Heart of an East Indian woman, aged 21, who died in hospital,
showing great thickening, rigidity, and opacity of the mitral
valves, particularly of the anterior flap, and consequent conti ac-
tion of the mitral orifice, which barely admits one finger (incipient
“ button-hole constriction ”).

112- Section through the base of the heart to show an abnoimally
puckered, thickened, and coherent condition of the middle and

SERIES VI.]

MITRAL STENOSIS.

139

right aortic valves, so that the aortic orifice appears as if guarded
by two valves only.

Taken from an European male, aged 35, who died from acute sloughing
dysentery, with multiple abscesses of the liver. No rheumatic or
syphilitic history.

113. A very beautiful example of “button-hole constriction” of the
mitral orifice. Both flaps of the mitral are conjoined, are greatly
thickened, opaque, and rigid. Their chordae tendineae have dis-
appeared, the margins of the valves being united directly to the
apices of the papillary muscles. There is a narrow slit, not
larger than a crow-quill, left between the conjoined flaps, and
forms are unyielding, rigid opening between the left auricle and
ventricle. The aortic valves are also thickened and opaque, the
right valve is ulcerated and perforated. The left ventricle and
auricle are both dilated, the latter especially so, and the right
cavities of the heart still more so. From a native female, aged
35. Five years previously to admission into hospital for heart
disease, she had suffered from syphilis. There was no history
of rheumatism. There was general anasarca of the whole body.
A loud pre-systolic murmur was audible at the apex. The first
sound at the base was indistinct, the second accompanied by a
regurgitant murmur. There was much dyspnoea. She died
from exhaustion and asphyxia. ( Presented by Professor Chucker-
butty.)

114. A portion of the left ventricle, with the aortic and mitral valves,
from a native woman, aged 40. The specimen exhibits extensive
disease of both mitral and coronary valves. The latter are of
cartilagenous consistency, greatly thickened, irregular or puckered
and coherent ; the opening or space left between them was not
much larger than a goose-quill. The mitral flaps are similarly
affected, are coherent, and adherent to the papillary muscles, the
chordae tendineae having almost completely disappeared. Between
the valves is left a slit or chink-like opening, through which a
glass rod has been passed. It is a very characteristic example
of the so-called “ button-hole constriction ” of the mitral. The
heart was in a state of hypertrophic dilatation, particularly the
right chambers. It weighed 14 ounces. (See further, “ Medical
Post-mortem Records,” Vol. I, 1873, p. 90.)

' 115- 1 he heart of a European (male) patient, aged 36, who died in
hospital. Ihere is considerable fatty deposit on the external
surface. The right cavities are dilated, and their walls some-
what thinned. The tricuspid and pulmonary valves are healthy.

he left ventricle is hypertrophied and dilated. Its walls are
abnormally thickened and firm, except at the apex, where they
are thinned out. The aortic valves are greatly thickened and
puckered or crumpled; the middle and right valves united
together; the former perforated near its free margin. The
aorta, just above these valves, exhibits two small patches of athe-
romatous thickening. The endocardial investment of the mitral
valves is a little opaque; the left auriculo-ventricular opening
wide ; the auricle much dilated. The patient stated that, about

140

DISEASES OF THE HEABT.

[series VI.

116.

117.

twenty years ago, he had suffered from acute rheumatism, but
without any chest complication. Twelve years ago he liad
syphilis. (See further, “ Medical Post-mortem Kecords, Vol. I,

1873, p. 100.) „ . , , , . ,

Chronic rheumatic endocarditis. The left auricle and ventricle

are preserved, showing slight thickening and opacity of t ie
general endocardial lining of these cavities and of the aortic
valves, while the chief change is in the mitral val ves. Both
flaps of the latter are much thickened, the chorda; tendinea; foie-
shortened and rigid, the orifice contracted, and the valves quite
incompetent. From a native female, aged 20, who had suffeied
from acute articular rheumatism at the early age of four years
and had ever since then been subject to frequent attacks of

dyspnoea and palpitation. , ,

Heart showing extensive disease of the mitral valve, and hype -
trophic dilatation of the left auricle and right chambers.

On the ventricular aspect the mitral valves are seen closely drawn
together, thickened, and rigid : the chorda tendinea fore-shortened,
the muscular papilla almost touching the margins of the valves.
On the auricular aspect there is great inflammatory thickening a
round the mitral orifice, with recent warty vegetations thickly
distributed upon the same. The orifice itself is reduced to a
mere chink (stenosis), which barely admits a glass rod as thick
as a crow-quill (see preparation). Altogether a very typical and
characteristic specimen of the so-called “ button-hole con-
trietion” of the mitral. The right auricle « greatly dilated,
is almost the size of an ordinary ventricle. Imbedded m its
walls, especially in the appendix, are several globular ante-mortem
vegetations or fibrinous concretions, which vary in size from
a "hazelnut to a pea. The smaller ones are solid, composed of

concentric or laminated fibrin, undergoing decolourization. The

larger are similarly composed, laminated at the periphery, but
hollow at the centre, and on incision a little opaque, mnky,
fluid (disintegrating molecular fibrinous material) escapes.

The natient a native male, aged 50, was brought into hospital m a
^moribund condition, suffering from great dyspnoea, and died
within six hours of admission. No history of his ihness could
therefore be elicited. ( See further, “Medical Post-mortem

Tim mitral flaps are blended together
SO as to leave only a small semi-lunar chink, which barely adir-
the tip of the finger. This is well seen from the auiicular
side The coronary valves are also much thickened and
mrtiallv coherent. The left auricle and the right cavities of
the heart are dilated-- From a native woman, aged about 4 ,
admitted moribund. No special history could be obtained.
(See further, “ Medical Post-mortem Records, Aol- 11, 187/,

A se?tfon4from the base of the heart of an American seaman
Teed 45 who died in hospital from pulmonary phthisis. The
aortic valves are alone pressed. These exhibit great thicken-

118.

119-

SEBIES VI.]

VALVULAR ENDOCARDITIS.

141

ing, cohesion, rigidity, and superficial ulceration, evidently
chronic in character, and producing considerable contraction
of the aortic orifice. (“Medical Post-mortem Records,” Vol. I,
1878, pp. 729-30.)

120- Calcareous, nodulated thickening of the aortic valves. The
central segment is principally involved. On its ventricular
aspect, at the junction with the right lateral valve, is a
globular swelling, the size of a sparrow’s egg, the deeper portion
hard and calcified, the superficial soft and fibrinous. At the
centre it is ulcerated ; a perforation exists, through which a
fine glass rod has been passed ; and on the aortic aspect of

the same a fibrinous thrombus, an inch in length, is firmly

attached by its base, the other end lying free in the aorta. The
left lateral coronary valve exhibits calcareous thickening at its
centre, taking a nodulated form, and almost filling the sinus
of Valsalva immediately behind it. The mitral valve is

thickened, but not calcareous. The left ventricle is greatly
hypertrophied, and its cavity also dilated. No history. ( Pre-
sented by Professor Edward Goodeve.)

121. • “ Heart, the left ventricle of which is hypertrophied. There

are hard calcareous deposits on the aortic valves. The

endocardium of the left ventricle is thickened. The sinuses
of Valsalva are inordinately dilated, but the lining membrane of
the aorta is healthy ” (Ewart). The calcareous thickening of the
valves is most remarkable. Their ventricular surfaces and
free margins are studded thickly with minute, hard concretions,
some being conical, and even pointed. Two of the valves have
coalesced along the entire extent of one-half of their opposed
margins— from the aortic insertions to the corpora Arantii —
so that virtually the aortic orifice is guarded by two valves only.
The coronary arteries are dilated, and their walis atheromatous.

122. A section from the left ventricle of the heart, exhibiting re-
markable stenosis of both the aortic and mitral orifices.
The former is so much contracted that it will barely admit the
tip of the little finger. The coronary valves are conjoined,
rigid, tuberculated, and calcareous. The mitral orifice is'
represented by a transvere slit, about three-fourths of an inch
in length, the margins of which are also much tuberculated,
hardened, and partially calcified; the auricular aspect is,
moreover, deeply fissured and ulcerated at one extremity. The
left ventricle was hypertrophied and dilated, the left auricle
much dilated, and the right chambers of the heart also showed
hypertrophic dilatation. From a European, John D., who died
in hospital on the 16th September 1870.

123. The heart of a European patient, who died in the Presidency
General Hospital, showing very remarkable obstructive disease
at both the mitral and aortic orifices. The former is so much
contracted that it barely admits the tip of the finger • its
margins are rough, hard, partially calcareous, and the whole
onhce forms a mere triangular-shaped unyielding, opening- a

142

DISEASES OF THE HEAET.

[SEBIES VI.

rio-id diaphragm— between the auricle and ventricle. The

curtains of the valve are also thickened, their chord® tendmese
fore-shortened and opaque. Similar changes, but not so
marked or advanced, obtain at the aortic orifice. The coronary
valves are partly conjoined, their free margins rounded and
irregular,— altogether incompetent. No history received, {Pre-
sented by Dr. W. J. Palmer.) . , ,

124. A section from the aorta with the coronary valves which show
chronic atheromatous changes. The central and right valves aie
especially thickened, rigid, slightly tuberculated and calcareous.
Their adjacent halves-from the aortic attachments to the
respective corpora Arantii— conjoined. From a native male, aged

40, who died of cholera. . . Mir

125. The heart of a native female patient, who died in hospital from
acute articular rheumatism, complicated with . carditis. The
preparation shows evidences of (1)_ pericarditis, in the form o a
soft granular layer of lymph, which coats both surfaces of t e
heart, and is very distinct at the base, on the posterior aspect of
the right auricle and ventricle ; (2) endocarditis, the lining
membrane of the whole of the left ventricle abnormaHy opaque
and milky-looking ; the mitral valves not affected but, at the
junction of the right and middle aortic valves is a large, recent
fibrinous vegetation (about the size of a hazelnut) irresular
in outline, and hollowed out at its centre ; the left valve is per-
forated (position and size of perforation shown by a glass iod).
Lastly, the whole thickness of the ventricular wall, just below
and behind the aortic vegetation, has undergone ulcerative soften-
ing and perforation ( myocarditis ), so that a communication has
been established between the two ventricles, by a somewhat
ragged opening, sufficiently large to admit a director. Its posi-
tion is indicated by another glass rod. This aperture is par tially
overlapped in the left ventricle by the vegetation above described
in the? right ventricle it was found plugged by a fibrinous clot,
which has been removed, and is now attached by a piece of thread,

126 SartVaTatWe male fMahomedan); aged 25 who was

12 ’ admitted into hospital in a moribund condition, with a history of

having suffered from “fever ” for eight days. There was much
dyspnma, and a temperature of 1U4°F. He died within twelve
hours. The middle and left coronary valves are seen thickly
studded with soft, recent, warty vegetations ; Hie middle valve is
also ulcerated and perforated at its centre There was no peri-
carditis. {See further, “ Medical Post-mortem Records, Vol. I,

197 ExtenSve thickening and ulceration of the coronary valves, the

127 ventricular surfaces of which are covered with soft, fibrinous,
warty vegetations. The aortic orifice is much constricted. The
1 £. vpntricle is widely dilated, and to a certain extent hyper
trophied ; the left auricle and right chambers of the heart * °?
similar changes. From a native male, aged 44, who died m

hospital.

SEBIES VI.]

ANEURISM OF MITRAL VALVE.

143

128.

129-

130.

There

J 131.

’•The di

A section from the base of the heart of a Mahomedan
prisoner, Ramzan Alii, aged 30, who died in the Allahabad
jail hospital from acute valvular endocarditis. The aortic
valves are seen much thickened and opaque. The central
and right flaps are imperfectly separated, so as to give the appear-
ance of two valves only at the aortic orifice. The remains
of the thickened cord-like septum between these valves is, how-
ever, recognizable. The left valve is thickly studded with soft,
whitish, granular or warty vegetations, which form a complete
fringe over the upper half of the ventricular aspect of the valve,
and along its free margin. The endocardium, at the junction of
this left valve with the central flap, is deeply ulcerated, and
covered for half an inch below the ulcer by minute, reddish,
recent inflammatory granulations. The left free edge of the
central valve bears a rounded soft vegetation, rather larger than
a pea, and a similar, but smaller, growth exists just below the
corpus Arantii of the right coronary valve. There are traces of
endocarditic thickening on the ventricular surface, and a few small
vegetations at the free margin of the anterior flap of the mitral,
which has been preserved. The left ventricle was much dilated,
and its walls at the same time thickened. The whole heart
weighed 15 ounces. (Presented by Surgeon Shirley Deakin,
f.b.c.s., Officiating Superintendent, District flail, Allahabad.)
Aneurism of the anterior flap of the mitral valve. The specimen
was obtained from a native female received into the Campbell
Hospital, Calcutta, in a moribund condition, and who died a few
hours after admission. No specific history was therefore obtain-
able. The aneurismal pouch is the size of a small hazelnut, and
has ruptured into the left auricle. The orifice of the little sac
is situated at about the centre of the ventricular aspect of the
anterior flap of the mitral, and is large enough to admit a crow-
quill. A thin layer of coagulum was found lining the pouch
in the recent condition. The aortic valves, particularly the
middle valve, and the endocardium immediately b<4ow it, are
covered with recent fibrinous, warty vegetations, and a good
deal crumpled and thickened. The lining membrane of the
aorta is atheromatous. (Presented fy'Moulvie Tameez Khan,
Khan Bahadur, Lecturer on Medicine, Campbell Medical School.)
Heart, showing slight thickening of the mitral valves, and a
small pea-like aneurism, situated at the centre of the anterior
flap. Its orifice is directed towards the ventricle, the little
pouch or . sac towards the left auricle. The muscular tissue of
the heart is pale and soft.

was no evidence of this lesion during life. From a native male
(Hindu) aged 23 years, who died in hospital from chronic
catarrhal pneumonia.

“ Vegetations upon the aortic and mitral valves, with dilatation
and hypertrophy of the left ventricle ; rest of the heart healthy.”
(Allan Webb: Patliologia Indica, No. 809, p. 32.) J

>ease is most marked in the aortic valves, the left flap of which
has ulcerated, and been thus divided transversely into two portions,

144

DISEASES OF THE HEART.

[series VI.

132.

133

134.

135.

136.

an upper and a lower, upon both of which vegetations have
formed. The middle valve is greatly contracted, and covered
also with large warty vegetations. The 'right valve is puckered
or crumpled, and quite separated from the middle by an uiceratcd
fissure Almost the whole of the ventricular aspect of the
valve is deeply eroded, and the margins and surface of
fte disintegrating lamina are crowded with vegetatmg villous

S'cutevalvular endocarditis, associated with articular rheumatism^

The curtains of ^^n^Xn ollhe whl " the

iIftt'Vventricle10Iis abnormally thickened and opaque-looking.

cfrnoture healthy. Specimen taken from Ramom,
Muscular struc 30f wiro died from rheumatic fever on

a Hindu ‘ > <Jm;ss;on. When admitted, in addition to

the Articular inflammation, a loud mitral regurgitant murmur

The teirtof a Mahomedan lad, aged 19, who died in hospital
lhehcaitoi a. thickened and shrunken, their

The aortic val d with luxuriant warty vegetations,

ventricular su. aces coveiea ^ ^ ^ curtajns of the mitral

Similar giowth an ^ c | , iong) and somewhat tongue-

Vhlned°"L0is^own from the lower margin of the anterior
shaped < n . , cavity. Numerous minute vegetations

flap m\<tered Ive th ^ endocardium of the left auricle. The
are scatteied ovc immediately above the coronary

lining membrane of the erosions, each about the

voices preMOte two ^ Tentricle is somewhat hypertrophied
size of a split pea. J-1 valves. The right and left

Warty vegetatmns o ventricular aspects, hard,

segments both exhibit 0,1 ientl calclfied. The ventri-

rough growths who and hypertrophied. No history.

rflrCaVl^vtnckelint of the mitral valves, with the projee-
Inflammatoiy thicke * a large, irregular-shaped, partially

tion into the leit vent f horse-bean. It is

calcified vegetation about the^size ^ flap a(. its

W^hik the other end floats free, and is directed towards the
base, while the oi ^ & little opaque and crumpled.

S tfrricH both hypertrophied and dilated. From a native
Christian female. , , a heffffar, who was admitted

attack of articular ipirmpd The tricuspid valve

ventricle is dilated and its walls Ihmn d. J ^ divisions> The

has a large fibrinous veg , d • to an irregular ring by warty
pulmonary valves are conv ^ Qf pVOper valve -structure

vegetations, on y ™ J the mitral were slightly thickened ;

thS “lives healthy!” The whole heart is atrophied and

series vi.] FIBRINOUS CONCRETIONS OR POLYPI.

145

small. ( See further, “ Medical Post-mortem Records ” Vol. I,
1875, pp. 859-60.) ( Presented by Surgeon Gerald Bomford, m.d.)

137. A magnificent example of a cardiac polypus. The growth is
about the size of a small orange, oval in shape, attached by a
firm pedicle to the upper part of the right auricular wail, a little
to the inner side of the opening for the superior vena cava. It
measures 5-*- inches in circumference, 2i inches in longitudinal
diameter, If inches transversely. The upper free surface is rounded,
the lower grooved as if by the current of blood from the superior
cava to the auriculo-ventricular opening. The upper part of the
polypus exhibits on one side an irregular mass, which bears the
impress of the appendix auriculie, and was doubtless formed within
it ; the main bulk of the growth, however, belongs to the auricle
proper, and hangs loose (i.e. attached by the pedicle only)
within that cavity. On section, the polvpus is firm, particularly
at its base, of a pale reddish-brown colour, with here and there
small portions opaque-white or yellowish. The endocardium
lining the auricle is reflected from the pedicle over the entire
polypus, can be separated with the forceps from the substance
of the growth, and exhibits under the microscope the delicate
filamentous structure and epithelial covering which characterize
the endocardial membrane.

Microscopic sections from the polypus itself show a delicate, reticulated
structure, permeated by numerous blood-vessels and capillaries
passing inwards from the endocardial investment into the sub-
stance of the growth, and being especially well marked at the base
or pedicle. The interstices are filled up with blood-cells, by a dark
pigment matter (hsematoidin), and a new cell growth exhibiting a
tendency to conversion into immature connective tissue ; all of
which conditions evidently indicate that the polypus had been of
some duration, and was considerably advanced in “ organization.”
The auricular wall is much thinned and dilated. The tricuspid
valves are short, and their chordae tendineae thickened and stunted.
The pulmonary valves are healthy. The foramen ovale is closed.
The aortic valves are thickened, puckered, and slightly fenes-
trated. The mitral valves are also slightly thickened and
opaque. The coronary arteries are healthy, but the veins are
much dilated, and the coronary sinus in the right auricle is
abnormally wide. No large blood-vessels can be traced into
immediate proximity of the polypoid growth ; it does not, there-
fore, appear to have originated as an extravasation of blood beneath
the endocardial membrane, but is probably the result of inflam-
matory changes (endocarditis), perhaps in part congenital. The
impediment to the current of blood offered by such a large
polypus must have been very considerable. No history.

( Presented by Professor F. J. Mouat.)

.138. “ Heart and right lung. The right ventricle and the ramifications
of the pulmonary artery are laid open to their minute divisions,
showing the existence of ante-mortem coagula within them.
From a native prisoner, who died phthisical, and with an abscess
between the rectum and bladder” (Ewart). This is an example,

146

DISEASES OF THE HEART.

[series VI.

139.*

140.

141-

142.

143.

These

probably, of the firm fibrinous variety of coagulum, which, in
rare instances, forms during the articulo mortis in asthenic indi-
viduals, with a slow, enfeebled, and embarrassed circulation.
(Presented by Dr. Beatson of the General Hospital.)

“ Heart of a Hindu, aged 30, who died of pyaemia 18 days after
his right femoral artery had been tied in Scarpa’s triangle for
elephantiasis of the lower third of the leg. The femoral artery
and vein, and the iliac veins are healthy ; a minute abcess was
found in each kidney. Both lungs were full of patches of dead
tissue, surrounded by zones of red hepatization. The piepara-
tion shows a large ante-mortem coagulum, occupying the right
ventricle, and extending into the pulmonary artery, and into
its main branches. The clot has taken a cast of the three
pouches behind the sigmoid valves. The left ventricle and
aorta are occupied by a smaller coagulum ” (Colies).

“Heart of an adult Hindu, who died of phthisis, to lllustiate
the formation of coagula in the heart where death is protracted.
A large coagulum is seen entangled in the right ventiicle,
which originally extended into the pulmonary artery. A much
smaller one is seen in the left ventricle, extending thence for
some distance into the aorta.” (Both coagula have been torn
across so as to form two portions.) (Colies.)

“ Large ante-mortem coagula, found in the heart of a Musalman,
a^ed 20, who had suffered occasionally, for a month previous y,
from ordinary intermittent fever, and died suddenly without
apparent cause. The large coagulum on the top was found in
the right auricle, the next in the right ventricle, the third m the
left ventricle, and the two long coagula at the bottom in the
vena cava, near the liver. All the coagula were ‘ of a pale colour,
and closely resembled in colour and appearance halt-cooked veal,^
but at their free edges merged into ordinary coloured coagula
(Colles). (See mlso, Indian Medical Gazette, May 1868, p lOo.

{ Presented by Dr. J. R. Jackson, Superintendent, Meerut Central

An ante-mortem clot, which filled the right ventricle and extended
i lono- way up the pulmonary artery and its branches. _ It
occurred in an old woman (Irish descent), who was undergoing
treatment (for leprosy) by gurgan oil, internally and externally,
ind apparently with some benefit. She suddenly got intense
lyspnoea, and I diagnosed this condition, pulmonary embolism,
is there was nothing else to account for her sudden and distressed
condition of dyspnoea. The specimen is useful as showing a com-
mon mode of death.” ( Presented and described by Dr: J. Ewart.

“ Ante-mortem depositions of fibrin-like ribbed buttons, attached
to the right auricular wall by their pedicles ” (Ewart) .

ire characteristic, ante-mortem cardiac thrombi ot the vane y
jailed “ globular vegetations ” by Laennec. They are firmly fixed
by narrow pedicles in the small interstices between the muscula
crabeculai of the auricular wall. The largest flattened and some-
tvhat fan-shaped, is the size of a hazelnut, the others like peas.
Ihey are hollow, or composed of solid laminated fibrin.

series vi.] GLOBULAR ANTE-MORTEM VEGETATIONS.

147

144. “ The heart of a patient named Ivureem Khan, who died of
asthma.” The right ventricle is dilated. Imbedded between
the column® came® are numbers of globular vegetations
(thrombi'), hollow centrally, and, in the fresh state, found filled
with purulent-looking fluid, which yet contained no pus-cells
when examined microscopically, but consisted evidently of
softened broken-down fibrin. These globular vegetations vary
in size from that of a sparrow’s egg to that of a pea, and some
are smaller.

145. Heart laid open, showing numerous minute, globular vegetations
imbedded firmly amidst the intersections of the muscular trabe-
culae of the left ventricle. They vary in size from a large barley-
grain to a pea, and consist of decolourized fibrin ; some of them are
hollow, while others are solid and laminated The heart is some-
what small (weight 7| ounces), and the muscular walls atrophied.
From a native male patient, aged about 40, who died in hospital
from pulmonary phthisis.

146- The heart of a native woman, aged 22, who died from pelvic
peritonitis, following “ instrumental labour.” Two globular fibrin-

147.

148.

ous vegetations, one the size of a large pea is seen attached to
the free margin of the posterior tricuspid flap, the other, the size
of a hazelnut, at the junction of the right and middle aortic
valves. These vegetations are of a pale-buff colour, soft, and
friable. That on the aortic valves is partly disintegrated, and its
surface in consequence rugged and broken down. Both exhibit a
hollow interior, and a concentrically laminated disposition of the
fibrin composing them. They are undoubtedly ante-mortem.
(See further, “ Surgical and Obstetric Post-mortem Records,” Vol.
I, 1876, p. 342.) •

A hollow, globular, ante-mortem vegetation, attached near the
apex of the right ventricle to the muscular wall, and also to the
posterior and inferior flaps of the tricuspid valve. It is the size
of a plum. From a native male, aged 38, who died from
pneumonia.

A very large globular thrombus or dendritic, ante-mortem,
fibrinous vegetation, attached firmly to that portion of the auricular
wall which lies between the superior and inferior caval openings.
It is the size of a hen s egg. The upper part is rounded and
smooth where it has projected into the appendix auricula?. The
lower part is broader, and, in this situation, the thrombus was
found to have softened and given way, discharging its yellow-
ish-white, cream-like contents into the auricle and ventricle.
1 n the latter, particles of the same, mingled with fluid dark bloodj
filled the cavity, and the pulmonary artery was also largely occu-
pied, but not absolutely obstructed, by the same material, which
moreover, was traceable into the smallest branches of this vessel
in both lungs. In the pre-softened condition this thrombus
must have almost completely filled the right auricle. From a
native male patient, aged 40, who died in hospital from cirrhosis
of the liver and ascites, &c. (See further, » Medical Post-mortem
Records,” Vol, II, 1878, pp. 853-54.)

148

DISEASES OF THE HEART.

[SEEIES VI.

149. Heart, exhibiting a bifid condition of the apex, the right ven-
tricle descending below the left. From a native male, aged
30, who died from pulmonary phthisis.

150. Heart with bifid apex. From a native male patient, who died
from fibroid phthisis.

151 Congenital perforation of the septum ventriculorum, with
valvular endocarditis of the right side of the heart. Fibrinous
vegetations surround the right auriculo- ventricular opening,
and are attached to the margins of the tricuspid valve.. A
little below and behind the superior flap of this valve is a
perforation of the inter-ventricular septum, an opening capa-
ble of admitting a crow-quill, and through which a green glass
rod of this size has been passed. The corresponding orifice
in the left ventricle is situated just below the point of junction
of the middle and left coronary valves, and is provided with a
valve-like arrangement of thickened endocardium, which pro-
bably prevented, to considerable extent, the passage ^ of blood
from the left ventricle into the right, but not vice versa. A few
small fibrinous vegetations surround the left auriculo-ventricular
opening. The foramen ovale has quite closed, but the
Eustachian valve is unusually developed and distinct. “ The
little girl to whom this heart belonged was. of Armenian
parents, born in Calcutta, aged 7 years ; was delicate and puny
from her birth, subject to fever of remittent type, and to its
sequelae, - spleen and glandular enlargements. From birth some
peculiarity was observed in the heart’s action, attributed to
imperfection of the valvular apparatus (and probably patency
of the foramen ovale). As she advanced in life the disturbance
became greater, the heart’s action irregular and tumultuous. No
distinction could he observed of the nature of a double heat,
hut each contraction seemed to engage both ventricles at once,
and the sound was unlike anything, unless the forcing of water
through a sieve. During the last ten months there had been
gradually increasing anasarca and accumulation of fluid in
the pericardium, encroaching enormously on the cavity of the
thorax, and impeding respiration. It should he mentioned
as a curious fact of the family history, that the parents for
several generations have been blood-relations, that the child s
mother for several years of infancy suffered from similar
symptoms of heart disease, that two of the other children have
exhibited malformation or mal-development of parts, i.e. cleft
palate, &c.” {Note by Professor Stewart.) Webb’s Pathologia
In die a, No. 1600, p. lvi.)

52- Heart showing congenital perforation of the septum ventricu-
lorum. The right auricle and ventricle are dilated, and their walls
thinned. The endocardium lining the ventricle immediately
above the superior tricuspid flap presents much thickening an
opacity over an irregularly rounded space, about the size ot a
rupee ; and the free surface of this patch was found a little
roughened and vascular, as if from recent inflammatory action.

series vi.] CONGENITAL MALFORMATIONS.

149

On the opposite wall of the ventricle, i.e. in the septum ventri-
culorum, one inch below the central pulmonary valve, is a funnel-
shaped perforation,, sufficiently large to admit a crow-quill. Its
direction is obliquely upwards, so that its orifice in the left ven-
tricle is situated about half an inch below the point of junction of
the middle and left coronary valves, at the triangular, fibrous, and
semi-transparent portion of the septum seen in most normal
hearts. This opening is wider than on the right side, and its
margins are surrounded by thickened endocardium. Free com-
munication evidently existed between the light and left ventricles
during life. The mitral and aortic valves are healthy. The aorta
is somewhat contracted and small. The muscular wall of the left
ventricle is a little hypertrophied, and its cavity slightly dilated.
Small globular, fibrinous vegetations are seen imbedded in the mus-
cular interspaces of the left ventricle, and again in the right
auricle ( ante-mortem ). The pulmonary artery seems to be a
little widened, but its lining membrane is healthy. There are
three coronary arteries, one originating in the right sinus of Val-
salva, and two in the middle. The weight of the heart is 11 £
ounces.

From a native woman, aged 20, who died from pneumonia after child-
birth. There were no symptoms observed during life indicative
of the cardiac lesion ; the latter was only discovered post-
mortem. ( See further, “Surgical and Obstetric Post-mortem
Records,” Vol, I, 1878, pp. 455-5G.)

153- Congenitally malformed and hypertrophied heart, weighing 15
ounces ; with also, the pulmonary artery and arch of the aorta.
The right ventricle forms the whole of the anterior surface and
apex of the heart. At the upper part of its cavity there are
three orifices or openings. One, directed upwards,— large, and
guarded by three normally formed, but somewhat sketched valves,
is seen to be the aorta. The aortic arch is well defined, and
gives off the usual number of branches, the vessel then descending
to the left side to form the thoracic aorta. The second orifice or
opening in the right ventricle is placed a little behind and below
the left lateral valve of the above aorta. It admits one finder,
with some difficulty, for about half an inch, when a membranous
ling is encountered, evidently constituted by three congenitally
conjoined valves, — the imperfect divisions between which are
readily recognizable. Through this ring the tip of the little
finger can only pass. Ibis is the pulmonary artery , much
reduced in size. It runs upwards, and, behind and below the
aorta, divides into right and left branches for the respective
lungs. The third opening in the right ventricle is situated
at the upper part of the septum. It admits two fingers, is
surrounded by a ring of thickened endocardium, and com-
municates directly with the left ventricle.

The right auricle is enormously developed, is fully as large as one’s fist.
Both the superior and inferior caval openings are distinct and
very wide. This auricle communicates,/?;-^, with the left auricle,

150

DISEASES OF THE HEART.

[series VI.

there being an almost complete absence of the inter-auricular
septum ; secondly , by means of a large patent “ foramen ovale ”(?)
with a rudimentary left appendix auriculae ; and thirdly , by
the same foramen, but separated by a narrow valve-septum,
with the left ventricle. This orifice of communication with
the left ventricle is guarded by two rudimentary valve-flappets
(? the mitral).

The left auricle, much smaller than the right, receives the pulmonary
veins from both lungs. It has no communication, with . the
left ventricle, nor with the rudimentary left appendix auriclae,
but as has been above described, is very imperfectly separated
from the right auricle, in fact, forms part of a common auricular

cavity.

The left ventricle is small and ill-developed. It communicates ( see above)
first, with the right ventricle ; and secondly, by a rudimentary
mitral (?) orifice with the right auricle, or dextral portion of the
common auricle. The muscular wall of the right ventricle is
enormously hypertrophied, -over an inch m thickness at . the
apex. It evidently takes the place of the normal left ventricle ;
and this remarkable heart thus consists in reality of but three
imperfectly formed chambers, -two ventricles and a highly
developed auricle. The admixture, therefore, of arterio-venous
blood must have been very considerable.

The subject was a Hindu female, aged 18, who died in hospital from a
laro-e malignant tumour (sarcoma) of the back. She was markedly
cyanotic ; and, on auscultation over the heart, a loud, rasping,
systolic bruit was heard both at apex and base, but most distinct
mid-sternum. The area of cardiac dulness was much increased,
and principally to the right of the sternum. A dilated right
heart, with probably patent foramen ovale, was diagnosed during
life but the very extensive cardiac malformations above described
were only discovered post-mortem. It is perhaps noteworthy to
record that the spleen was found congenitally multilobulated in
this case, consisting of no less than seven distinct and separate
lobules of varying size, only held together by investitures of loose
connective tissue and peritoneum. ( See further, “ Medical 1 ost -
mortem Records,” Vol. Ill, 1879, pp 381-85.) # ^

1 Zd. “ Heart of a uew-born infant, in which there is exemplified
arrest of development of a small portion of the septum ventu-
culorum. The opening is near the base of the ventricles, . an
is indicated by the insertion of a portion of wire. It is associated
with remarkable narrowness of the pulmonary arteiy. T
ductus arteriosus and foramen ovale are patent (Ewait).
(Presented by Professor R. O’Shaughnessy.)

1 “ Heart of an infant, five months old, with patent foramen ovale

155 and pervious ductus arteriosus. A small glass rod is passed

through the foramen ovale, and another, leading from le pu -
m on ary artery, is seen to traverse the ductus arteriosus, emerging
therefrom into the aorta ” (Ewart). (. Presented by Professor

Duncan Stewart.)

sebies vi.] CONGENITAL MALFOBMATIONS.

151

156.

157.

158.

159.

160.

161.

“ Atheromatous deposit in the pulmonary and tricuspid valves ”
(Ewart). This is a much more interesting specimen than can be
gathered from the above brief record, for it shows, 1$A 'patency
of the foramen ovale, — a vertical slit, capable of admitting a
crow-quill being observed at the upper margin of the fossa ovalis,
by means of which a communication exists between the two
auricles ; 2 ndly, thickening, opacity, and contraction of the
tricuspid valves, and much narrowing of the right auriculo- ven-
tricular orifice ; 3 rdly, almost complete obliteration — atresia — of
the pulmonary orifice. This orifice is represented by a hard, calca-
reous, roughened ring, composed of the con joined, highly atheroma-
tous pulmonary valves. In the preparation it has been cut
through. When the parts are brought together, a mere narrow
fissure remains, scarcely admitting the point of a probe, and
is the only opening between the right ventricle and pul-
monary artery. The latter vessel is a good deal dilated, and
its walls thinned. The right ventricle shows great hypertrophv
of its muscular walls; the right auricle both dilatation and
hypertrophy. The mitral and aortic valves, the left ventricle,
and aorta all appear to be quite healthy. There is no history of
the case recorded, but the lesions are undoubtedly congenital.

( Presented by Professor Edward Goodeve.)

Heart showing complete patency of the foramen ovale, which
measures an inch in length by half an inch transversely, and has
a smooth, rounded margin, with no trace of valve-structure. The
right auricle is dilated ; the right auriculo-ventricular opening
somewhat contracted ; tricuspid valves thick, opaque, fore-
shortened; pulmonary valves thin and attenuated; pulmonary
artery and its right and left branches greatly dilated ; ductus
arteriosus obliterated ; valves on left side of heart normal.
I he aorta gives off from the convexity of the arch an additional

branch, an artery about the size of an ordinary radial, originating
between the left carotid and left subclavian, and probably
lepresenting the left vertebral artery. No history. (Presented
by Professor Eatwell.)

Heart of an adult, with patent foramen ovale, indicated by the
presence of a red glass rod ” (Ewart).

Heart showing congenital patency of the foramen ovale. The
subject was a native Christian lad, aged 15, who died in hos-
pital from dysentery and pleuritis. The existence of this
condition was not suspected during life. The heart, otherwise
seems to be well developed. ’

Dilatation with slight hypertrophy of the right side of the
heart, and imperfect occlusion of the foramen ovale. A valve-
like opening exists, capable of admitting a No. 12 catheter
and thus a communication is established between the two
auricles. From a native male, aged 35, who died from chronic
bronchitis, with emphysema of the lungs.

“ A P°rtion of right ventricle and about half an inch of the

commencement of the pulmonary artery. The orifice

is seen

152

DISEASES OF THE HEART.

[series vt.

163.

164.

guarded by two instead of three pulmonary semi-lunar valves ”

162 (A preparation, showing the pulmonary artery provided with two
valves only. The calibre of the vessel above these valves is
considerably enlarged. The specimen was taken from a native
female, aged 20, who died from inanition and oedema of the lungs.

The condition is purely congenital. .

“ A preparation showing four instead of three pu monary senn
lunar valves. The supernumerary valve is scarcely half the size
of any of the other three valves ” (Ewart).

The "heart of a patient, who died from cholera. The aortic
orifice is guarded by two valves only, placed transversely. The
right halves of these valves are agglutinated together firmly ,
are thickened, rigid and hard from calcareous deposit Jhe le t
half of each valve is much expanded and thinned. The si: t o
chink left between these parts just admits the extremity of t
handle o£ a scalpel. The sinuses of Valsalva are «o"side™h ly
dilated. Tin* left ventricle is hypertrophied ; the right ventnc ,

on the contrary, is dilated and thinned. _

165 A section from the base of the heart showing the aortic orifice

165 guarded by two valves only. There is no evidence of endocar
ditis or thickening of these valves; the lesion appears to
congenital. — From” a Hindu (male), aged 21, who died in hospital

166 exhibiting" congenital absence of one aortic valve with

166‘ Sd adhesJand thickening of the opposed — « ‘he

two remaining A hard, cretaceous nodule exists at the point ot
cohesion, and both segments are a little

tous The left ventricle is not hypertrophied. Theie weic
evidences of this lesion during life. The patient, a
ncrorl 9ft died from diabetes. He is said to have been temperate
to habits, and had not suffered from either rheumatism or syptohs.
{See further, “ Medical Post-mortem Records, Vol. 11,
pp. 141-12). rp.

The aortic orifice of the heart, guarded by two valves only, the
Slit and central segments have conjoined to form one valve,
behind which are the orifices of both coronary arteries. Ap-
patently quite a congenital lesion,
a native male patient, who died of cholera.

erysipelas. (“ Surgical Post-mortem Records, Vo . , ’

conjoined ’from^their Adjacent aortic attachments forwards for

167.

From

168.

series vi.] CONGENITAL FENESTRATION OF VALVES.

153

, a single

one-half of each valve, and where separating anteriorly
corpus Arantii is developed. The septum also, which separates
these valves is imperfect and perforated, the opening as large
as a crow-quill. There is no thickening or any other indication
of inflammatory action in the production of these peculiarities, —
they are evidently congenital. The other valves of the heart
all healthy ; the organ itself somewhat small (weighing

were

170.

171.

172.

173.

174.

4/ '

G£ ounces), but otherwise quite normal. From a native male,
aged 24, who died from cholera. (“ Medical Post-mortem

Records,” Vol. II, 1878, pp. 761-62.)

Heart showing remarkable dilatation with hypertrophy of the
right cavities, thickening of the endocardium and flaps
of the tricuspid valve, and some dilatation of the pulmonary
artery. The auriculo-ventricular opening is wide, admitting
five finders easily. In the appendix auriculae, and along the
ventricular septum are globular vegetations ; ante-mortem , hollow
thrombi, varying in size from a pigeon’s egg to a millet-seed.
The left ventricle is small ; mitral valves a little thickened, and
the mitral orifice slightly contracted. The aorta is hypoplastic,
congenitally narrowed and small. From a native boy, aged 15.
The heart weighed 12 ounces.

“ The heart of a Sikh,” showing a cribriform condition of the
aortic valves at their upper free margins.

Congenital cribriform condition of the aortic valves. From a
native woman, who died from abdominal aneurism.

Congenital fenestration of the aortic valves near their free mar-
gins, particularly of the central valve. From a native lad,
aged 17, who died from pneumonia complicating dysentery

175.

176.

177.

Aortic valves, showing fenestration at their free magins, but
otherwise quite healthy in structure. From a native male,
aged 25, who died from cholera.

Congenital fenestration of the aortic and pulmonary valves,
wlflch are otherwise quite normal. A section from the heart of
a native woman, aged 30, who died from empyema,
fenestrated or cribriform condition of the coronary and pulmon-
ary valves at their superior or free margins. From a native
male, aged 30, who died of cholera.

fenestration of the pulmonary and aortic valves, apparently
congenital. These structures are otherwise quite healthy.

A section from the heart of an Abyssinian sailor (lascar), who died from
acute sloughing of the scrotum.

Remarkably (large) fenestrated aortic and pulmonary valves
(congenital). From a case of chronic dysentery — a native male
ased about 35. ’

Aortic and pulmonary valves, showing minute congenital fenestra-
tion of their free margins, while the general structure of these
valves is healthy. From Russick Das, a Hindu, aged 27 who
uied from pulmonary phthisis.

Preparation exhibiting a similar condition of the coronary and
pulmonary valves. From a native (male), aged 37, who died

178.

179.

480.

154

DISEASES OF THE HEART.

[SEBIES VI.

The

from secondary haemorrhage after the operation of excision of
an elephantoid scrotum.

181 A portion of the right ventricle of a horse, showing a warty
fibrinous vegetation, about the size of a nutmeg, attached to the
free margin and chordae tendineae of one of the flaps ot the

tricuspid valve. , 1 •,

“ The subject was a black horse, who had been worked hard, and reduced
to a great state of debility. He died four days after admission
into the veterinary hospital. The immediate cause of death
was enteritis and diarrhoea ; there was also gieat ciopsy o le
belly.” ( Presented by K. S. Hart, Esq., M.K.C.v.s., Calcutta.)

10 o A small atrophied heart from an aged Bengali showing calcareous
degeneration of the coronary arteries. Both vessels have been

exposed at their origins, and slit up for a short distance. Their

hard and brittle coats, tortuous outline, and opaque lining
membrane can be readily distinguished.

whole of the thoracic aorta, as well as the abdominal, till its
bifurcation into the common iliac arteries, and also the rig i
external iliac, for about an inch and a half, were found infiltrated
with the atheromatous deposit.” (Allan Webb, Pathologia lndica ,

Ismail atrophied heart with thickening and opacity of the aortic
and mitral valves, and a rigid, tortuous, calcified condition ot the

coronary arteries. , „ , ,

an aged East Indian (male), who died from dysentery.

Calcareous degeneration of the coronary arteries. These vessels
are seen to be remarkably prominent, a little dilated, toi tuous,
and their walls thickened and calcified. The aortic valves* and
aorta (both thoracic and abdominal) were similarly ; affe^
The heart itself is small and atrophied, weighs 5? ounces. From
an East Indian woman, aged 77 who di^ from chiomc
dysentery. (“Medical Post-mortem Records, Vol. Ill,

185 A* small atrophied heart, with a thick deposit of yellowish fat on
185’ its external surface. The muscular tissue, especially that of the

rieht ventricle, is much thinned, measuring only from two
to7 four lines in diameter. It is generally softened, and m a state
of fatty degeneration. The coronary arteries are varicose, ngi ,
and atheromatous, and the lining membrane of the aorta show
similar changes, especially around the origin of the abo

Taken from a native female, aged 27, who died suddenly, and within
two hours of admission into hospital, with symptoms of ang
pectoris. (See further, “ Medical Post-mortem Records, Vol. J,

186 A h°ypPe?trophied ind dilated heart, found associated with marked
186‘ granular degeneration of the kidneys. The aortic valves are

thickened and partially calcified. The whole of the arch of the
aorta presented^ great atheromatous thickening, with dilatation
of F th J1 ascending portion. The orifices of origin of the coronary
arteries are much contracted, scarcely admitting the point of

183.

From

184

series vi.] CALCIFICATION OF COEONAEY AETEEIES.

165

probe: this is due to calcareous thickening around them. The
interference with the nutrition, of the heart thus produced
probably accounts for its disproportionately dilated condition,
and for Ihe marked wasting and fatty degeneration of the muscular
structure, especially in the left ventricle. From a native male,
aged 53, who died from Morbus Brightii. The heart weighed
18-£ ounces.

187. “ Aneurism of one of the coronary arteries.” The preparation
exhibits a section from the aorta, with an aneurismal dilatation of
one of the coronary arteries. The sac is about the size of a
small hazelnut, and is partly lined by fibrin. The orifice
communicating with the sinus of Valsalva is smooth and rounded,
in diameter about that of a goose-quill. No history.

188. Abnormally high origin of the left coronary artery. A section
from the base of heart, including the aorta, has been preserved.
The orifice of origin of the vessel in question is seen to be situated
on the inner surface of the aorta, fully half an inch above the
central aortic valve and its corresponding sinus of Valsalva.

From a Hindu, aged 25, who died from cholera.

189. A section from the base of the heart to show the abnormal
origin of the coronary arteries. Both orifices of origin lie
close together, just above the point of junction of the right
and middle aortic valves, and quite above the sinuses of
Valsalva. From a native male, aged 30, who died from syphilitic
mvelitis, with paraplegia.

190. “ Portion of the femoral artery and vein in situ. The artery
was divided by the point of a knife in one part, into which a
red glass rod is now inserted. The division of the vessel is
almost complete, only a small fraction of its posterior wall
retaining its continuitv. The vein, into which a dark-coloured
rod is introduced, is untouched ” (Ewart).

There is no history. The inference is that the injury was accidental.
There are no evidences of repair. ( Presented by Professor
O’Shaughnessy.)

191. “ Laceration of the femoral artery, ' veins, and nerves, and the
partial plugging-up of the vessels near the points of injury ”
(Ewart). No history. {Presented by Mr. Covengton.)

192. A portion of the left femoral artery, from a native coolie (porter),
aged 50, whose thigh was crushed by the wheels of a railway
locomotive (engine) . The patient was brought to the hospital with
the limb almost severed from tbe body, and tbe femoral artery,
about the middle of the thigh, completely divided, yet pulsating
violently. No haemorrhage occurred owing to the laceration,
twisting, and contraction of the arterial walls, and, when am-
putation was performed higher up the thigh, this free end of
the vessel was found plugged by a firm coagulum. The
specimen illustrates well the effects upon blood-vessels of
lacerated and contused wounds.

193. Complete division of the right subclavian artery, due to a stab '
in the neck. The wound was deep and punctured, three-fourths

156

INJURIES OF BLOOD VESSELS.

[semes VI.

of an inch wide, and half an inch deep, situated immediately over
the sternal end of the right clavicle. The artery is seen to have
been severed in its “ first portion,” close to the origins of the
thyroid axis and vertebral artery. The injury was inflicted with
a sharp table-knife, by one Mahomedan upon another, — the
deceased (aged 30), during a quarrel. There was profuse
haemorrhage, and death took place in a few minutes, ( Presented
by the Police Surgeon.)

194. The knee-joint of a native patient, Nakched, a Mahomedan,
aged 25, who, ten days previous to admission into hospital, had
fallen from a height of about 18 feet upon the knee, without
fracturing the femur or bones of the leg, &c.

On admission, a tumour, resembling an abscess, was found in the left
popliteal space. It was laid open, and then seen to consist of
a cavity, which was filled with decolourized blood-clot, with a
sinus leading from it into the knee-joint. The latter was felt to
be extensively involved in the injury, and the limb was therefore
amputated at the lower third of the thigh.

The preparation shows rupture of the azygos articular branch of the
popliteal artery. Perforation of the posterior ligament of the
knee-joint (the aperture being ragged and soft, and admitting
two fingers) ; and, within the joint, the anterior crucial ligament
is seen to be detached from the upper surface of the tibia, bringing
away with it a portion of the spine of this bone, with the
investing cartilage. The other ligaments of the joint appear to
have preserved their integrity. A small piece of cartilage covering
the internal condyle of the femur is also chipped off, and the
whole synovial membrane of the joint thickened and vascular.

The popliteal artery itself, and all its other branches, except the one
already noted, are uninjured. The azygos branch is seen only
about two lines in length, the rupture having taken place close
to the main vessel. The rest of the artery could not be traced,
having probably become disintegrated and lost amongst the
sloughy condition of the parts immediately superjacent to the
joint.

195. The carotid arteries of two men who were hanged at the
Presidency Jail. The specimen shows how the coats of these
vessels have suffered from the violence inflicted upon them by
the fall. '1'he larger aorta and vessels are those of an adult
Hindu. The “drop” was six feet. The common carotid on
the right side, just below its bifurcation, has been completely
separated. The divided ends have also retracted, leaving
a space about a third of an inch in extent, where merely
the fibrous sheath of the vessel holds these parts together.
On the left side the injury has been less severe, and is situated a
little lower down. It consists of mere cracking or Assuring of the
lining membrane. The smaller specimen is from an Eurasian
lad. ^ Both common carotids exhibit rupture of the inner
tunic, the Assuring on each side being at about the same
level. The “ drop ” in this case was seven feet. In both men

SBBIES VI. j

CAROTID ARTERIES.

157

the thyroid cartilage was fractured. ( Presented by Dr. S. C.
Mackenzie.)

196. The arch of the aorta and its branches, from an East Indian
(male) hanged at the Presidency Jail. The carotid arteries are
exposed, and exhibit a transverse Assuring of the lining mem-
brane. This is situated on the right side, at a rather higher level
than on the left. The muscular and other coats of these vessels
appear to be uninjured. The arteries seem to have been forcibly
compressed at these spots by the rope, and the lesion is therefore
analogous to what takes place when a ligature is applied in the
continuity of an artery.

197. The common carotids, with their primary divisions, from a convict
hanged at Port Blair (Andamans). The man wTas a young
healthy adult (aged about 25). The “ fall ” given about five
feet. The knot was adjusted below the right ear. Death was
instantaneous, owing to fracture of the cervical spine and pressure
upon the cord. The right internal carotid is seen to be com-
pletely severed about half an inch above the point of its origin,
and the divided ends have retracted so much as to leave a consi-
derable gap between theffi. At the corresponding level of the
external carotid, a delicate crack in the lining membrane also
exists. The left external carotid exhibits a somewhat similar
lesion, a transverse linear rupture of the internal coat, but the
left internal carotid appears to have escaped altogether.

198. A specimen showing laceration of the internal tunic of the
right (?) common carotid artery. From a case of judicial
hanging.

199. “ Sloughing of the left subclavian artery after the application of

a ligature to the third portion of it, for the arrest of secondary
hiemorrhage. The vessel has been completely cut in two by the
disintegration of its structure, about an inch and a half from its
origin from the arch of the aorta. * # # # #

The vertebral, thyroid axis, profunda cervicis, superior inter-
costal, and internal mammary are matted together into one
mass by inflammatory exudation ” (Ewart). The divided parts
of the vessel are held together artificially in the preparation.

( Presented by Professor O’Shaughnessy.)

200. “ Preparation in which both common carotid arteries had been
ligatured for the cure of an ‘aneurism’ in the right orbit,
consequent upon an accident. Heart and great vessels with
trachea and larynx are in situ. The vessels are injected with
vermilion-coloured material ” (Ewart).

“This specimen presents several points of interest. The common
carotid arteries of either side have been obliterated and converted
into fibrous cords throughout the great part of their length,
remaining permeable only for about one-and-a-half to two inches
at their lower, and three-fourths of an inch at their upper
extremities. The circulation has been maintained mainly by the
inferior thyroid and vertebral branches of the subclavian vessel,
both of which are considerably augmented in size, especially the
vertebral of the left side. The ascending cervical branches of

158

LIGATURE OF ARTERIES.

[series VI.

the inferior thyroid on both sides of the body are enormously
developed. The external and internal carotid arteries have under-
gone very little change ; they are permeable throughout, and their
calibre but slightly decreased. Independently of the changes con-
sequent on the ligature of the great vessels of the neck, the
specimen is interesting as presenting varieties in the arteries
unconnected with the surgical operations. I he right subclavian,
instead of springing from the bifurcation of an innominate
trunk, is the last branch of the aortic arch, springing from the
left extremity of the transverse portion, and proceeding to its
destination behind the oesophagus and trachea, and immediately
in front of the vertebral column. The common _ carotids spring
from a short common trunk. On the left side the posterior
scapular springs from the thyroid axis instead of from the trans-
verse cervical, and the deep cervical is a separate branch . of the
subclavian. On the right side the thyroid axis is wanting, the
supra-scapular and transverse cervical are derived from the com-
mencement of the internal mammary, and the inferior thyroid is
a direct branch of the subclavian.” (. Described ly Professor
S. B. Partridge.) ^

The history of the case lias been furnished by Dr. Beatson, of the
General Hospital, under whose care the patient, Christopher
Quin awed 30, a seaman belonging to a ship lately arrived m the
Hooghlv, was admitted on the 14th January 1864, and died on
the 19th, anasarcous, with albuminuria. “ A year or more ago,
the patient said, while at New York, he received an injury to the
rio-ht eye, which was followed by swelling in the orbit, causing
protrusion of the eyeball. He was informed that this was an
aneurism. To cure it, the right carotid was ligatured by Pro-
fessor Mott, the American surgeon. He subsequently returned
to England, and the swelling not having disappeared, the left
carotid was tied at the eye infirmary. Beyond a whizzing
noise in his head, he experienced no peculiar sensation or mischief
from the operations; and the swelling m the orbit seems to
have ultimately disappeared.” ( Presented by Dr. Beatson, of the
General Hospital.)

The circle of Willis from the above case, showing “ extra develop-
ment of the left vertebral, the basilar, and right posterior com-
municating arteries.

Specimen illustrating the application of a catgut ligature to an
artery The axillary artery (with the vein) is shown, fiom
case m which amputation at the shoulder -joint was performed
and a carbolized catgut ligature applied to the divided end of
the vessel. The patient died torn W-mj »d -teo-mye ,t,s

on the seventh day after the operation. It will be ^ seen that
the ligature has been almost completely absorbed, and that the
artery is occluded in the usual manner by a decolourized fibnnou
SKSng upwards for about half: an inch t ,o tt .. =
large collateral branch. (Presented ly Professor H. C. CutcUtte,

F.K.C S., AC.)

201.

202.

SERIES VI.]

THROMBOSIS.

159

203. “ Trees of fibrinous coagula blocking up the branches of the
pulmonary artery and veins. From the right lung of a native
patient, who died after the operation for scrotal tumour, in
which acupressure was imperfectly applied. The tree on the
left, marked by a red glass rod, is from a pulmonary vein ;
that on the right, and marked by a black glass rod, is from the
pulmonary artery ” (Ewart).

These are both exceedingly common examples of the simple fibrinous
clot, so often found in slow death in asthenic cases. Judging
from their present size, they could not have “ blocked ” and
scarcely filled either the arterial or venous trunks.

204. “ Left lung of the above patient, in which the pulmonary
artery and its branches are laid open to illustrate the tree of
coagulated fibrin occupying them to their remote terminations ”
(Ewart).

205. Preparation showing portions of the right femoral artery and
vein, removed from the groin, together with a fragment of a
malignant growth. The walls of these vessels are seen to be
invaded by the growth, and the artery at one spot is ulcerated
and laid open. A sudden and severe haemorrhage from this
vessel was the immediate cause of death. On -post-mortem
examination, a few shreds of fibrin were found partially occluding
the rent, and there was a soft clot in the femoral vein. The
growth so intimately connected with these vessels is a part of
a large cancerous (epitheliomatous) mass, which involved the
lymphatic glands in the groin, and was apparently secondary in
development to an epithelioma of the prepuce and glans penis,
removed by operation eight months previously. Soon after
amputation of the penis, these lymph glands suppurated, and dis-
charging, left unhealthy ulceration of the skin and subcutaneous
structures in this situation (right groin). It was suggested
to the patient that a second operation — having for its object
the removal of this ulcerating mass— should be undertaken, as
it was suspected to be malignant, but he refused to submit to
the same. From a European, aged 32. (Presented bn Dr.
D. O’C. Raye, General Hospital.)

206 Atheromatous and calcareous degeneration of the whole of the
thoracic aorta, commencing just above the coronary valves.
In the ascending portion of the arch are several large, round,
“button-like” elevations, and numerous smaller tuberculated
growths, — all from atheromatous thickening of the internal tunics.
Above this, at the junction of the ascending with the transverse
portion of the arch, and involving the root of the innominate
artery, is an aneurismal dilatation, the size of half a walnut.
The arch then becomes narrower, but is still thickly infiltrated
with opaque, soft, and also hard calcareous deposits, the inner
surface being greatly roughened. The calcareous change assumes
the form of flattened or slightly concave plates of varying
thickness, and in numerous situations has the density and* feel
of bone. The margins of these plates are particularly irregular,

160

DISEASES OF THE AETEKIES.

[series VI.

207.

208.

209.

210.

211.

212.

213.

jagged, and sharp ; the intima in their immediate neighbourhood
ulcerated. ( Presented by Professor Allan Webb.)

“ Uniform dilatation of the ascending aorta with disorganization
of the aortic valves. The lining membrane is rendered uneven
by the deposition of atheromatous material. The same kind
of degeneration has led to the partial disorganization of the
semi-lunar valves. The diameter of the dilated portion is about
twice as large as that immediately succeeding it (Ewart).
“Atheromatous deposit and calcareous degeneration under-
neath and in the lining membrane of the thoracic and abdo-
minal aorta, with extensive erosions ol the tunic itself. Theie
is complete occlusion of the trunk of the vessel, just above its
bifurcation into the two common iliacs, by organized coagulum”
(thrombosis). “ From a case of elephantiasis scroti ” (Ewart).

( Presented by Professor Allan Webb.)

A portion of the thoracic aorta showing extensive atheromatous
thickening of the lining membrane, in the form of smooth, rounded
or irregular, slightly raised, and opaque patches, which thickly
stud the inner surface, and give it a remarkably uneven and
undulated appearance. #

“ The heart and aorta of a native female, in the decline of life,
the subject of tertiary syphilis, showing general dilatation, and
extensive calcarous degeneration of the entire aorta as far as
the cceliac axis. The woman always sat up with her head
hano-ing down, and it was evident that the brain was not duly
supplied with blood” (Ewart). The left ventricle is hyper-
trophied, the aortic valves thickened and rounded at their
free margins. Large calcareous plates are seen studding the
inner surface of the whole aorta some situated just beneath the
lining membrane, others bare, and having soft, granular, fibrinous
deposits attached to them. Just beyond the cceliac axis there
is a remarkable constriction of the mam vessel, a thickened,
rounded, firm hand stretching across the same ; the abdominal
aorta on the distal side, again exhibiting dilatation and
calcareous infiltration. {Presented by Professor Norman
Cli 6 vers. )

“ Extensive atheromatous and calcareous degeneration of the
ascending, arch, descending, and thoracic aorta. In many parts
the lining membrane is quite disintegrated. I here is consi-
derable dilatation of the ascending aorta ” (Ewart.)

Atheromatous degeneration of the whole ot the arch of the
aorta. The lining membrane is covered with opaque-white
patches and yellowish calcareous plates, and the ascending
portion is dilated. There is hypertrophic dilatation of the left
ventricle, and thickening and crumpling of the aortic valves.
From a European woman, aged 40.

The thoracic and abdominal aorta of a European (male) aged

68 who died from senile debility. The inner surface of the
vessel is exceedingly irregular and roughened from extensive
atheromatous and calcareous changes These may be traced
down to the origin of the common iliacs. About two inches

8EKIES VI.]

ATHEROMA OF THE AORTA.

161

above the bifurcation of the aorta, the calcareous infiltration
of its coats is most marked, and the calibre of the vessel is also
much reduced at this spot. (Presented by Professor D. B.
Smith.)

214. The aorta of a European (male) patient, aged 35, who died in
hospital from uraemia after cholera, showing extensive atheroma-
tous changes. The whole of the inner surface of the vessel is
seen studded with soft, dead-white, or yellowish patches, giving
an irregular tuberculated appearance to the lining membrane. The
ascending portion of the arch is in a state of fusiform dilatation.
There is no innominate artery. The right subclavian and right
carotid arise directly from the transverse portion of the arch, and
by separate orifices, just as the corresponding vessels of the left
side. (“ Medical Post-mortem Records,” Vol. I, 1875, pp.
501-502.)

215. The arch of the aorta from a native (male) patient, aged 65, who
died from pulmonary phthisis, showing a very highly atheroma-
tous condition of the lining membrane, which is raised into
numerous opaque-white and yellowish patches ; some soft and
smooth, others flattened and calcareous ; a few superficially
eroded.

216. The heart of a native woman, aged 50, who died from dysentery,
showing atrophy and fatty degeneration of the muscular struc-
ture, especially on the right side, where the ventricular wall is
only a quarter of an inch in thickness. The aortic valves are a
little thickened and opaque. The aorta throughout remarkably
atheromatous, its inner surface covered with large calcareous
plates, many of which are bare, with sharp abrupt margins, and
slightly hollowed or concave surfaces.

217. Arch of the aorta exhibiting marked atheromatous thickening
of the whole of its interior, especially of the ascending portion,
and at the roots of the large blood-vessels in the transverse
portion. The patches are soft, smooth, of a dull-white or waxy
appearance, and closely clustered — probably syphilitic. There' was
an indistinct cicatrix on the under surface of the glans penis
amygdaloid enlargement of the glands in both groins, and a
puckered, cicatricial-like condition of the right lobe of the liver.
From an American seaman, aged 34, who died from cholera.
(“ Medical Post-mortem Records,” Yol. II, 1876, pp. 35-36.)

218. A highly atheromatous and thickened condition of the arch of

the aorta, with, in parts, calcification. From “ a native, who
committed suicide by hanging ” ( Presented by Dr. R. D.

Murray, Civil Surgeon, Chittagong.)

219. Calcareous degeneration of the lower end of the abdominal aorta,
and of the common iliac arteries. No history.

220. The whole of the thoracic and abdominal aorta of an East
Indian woman, aged 60. The arch of the aorta is dilated, and
the entire vessel, as far down as the common iliacs, is extensively
diseased. The inner surface is covered with large patches and
plates of atheromatous thickening, many in a state of recent

162

DISEASES OF THE ARTERIES.

[series VI.

221.

222

223.

The

224.

ulceration (acute endo-arteritis), their margins and surfaces pre-
senting a bright^red, highly vascular condition (in the licsh
state), with fibrinous vegetations and fungus-like granulations
adhering to them. Several ot these recent ulcerations of old
atheromatous patches are of large size. Those not ulcerated are
firm, tuberculated, many calcareous. The aortic valves weie
rigid, contracted, and calcified ; the kidneys small and granular.
(See further, “Medical Post-mortem Records,” Vol. I, 1875,
pp. 505-6.)

Hio-hly atheromatous and calcareous degeneration ot the thoracic
and abdominal aorta. The orifices of origin of the large vessels
from the arch of the aorta are especially thickened and constricted.
At the junction of the transverse with the descending aorta, the
lining membrane is seen to be extensively fissured and ulcerated,
the muscular coat exposed, and the whole of. the structures
involved presented, in the fresh state, a highly injected and vas-
cular condition. The calibre of the vessel here is also dilated.
This atheromatous and thickened condition of the aorta extends
downwards into the iliacs, and even reached the femoral and pro-
funda arteries. From a native male, aged 50, who died from

cerebral apoplexy. .

A portion of the descending aorta, with the common iliac arteries,

exhibiting a greatly atheromatous and calcified condition
Large calcareous plates are seen projecting from, or lie imbedded
and hollowed out upon, the inner surface ot the aorta. There was
calcareous degeneration of the coronary arteries, and of the
arteries of the extremities (radials, tibials, &c). From an Eas
Indian (male), aged 81, who died in hospital from dysentery.

Extensive atheromatous degeneration of the whole of the aorta,
from the arch to the bifurcation into the common iliacs. I he
inner surface of the entire vessel is rough undulating, and
irregular from the presence of hard, embossed-lookmg, calcareous
patches and plates of varying size. In some places the latter
Lave given way, exposing deep, softened, and eroded surfaces. In
other oarts, the thickening extends to. all the tunics, and
renders" the wall of the vessel extremely rigid and brittle. 1 he
arch of the aorta is fusiformly dilated,
abject was a German Jew, aged 44, who died, in hospital. There
was a history of both syphilis and rheumatism. The. heait .was
greatly hypertrophied and dilated, the aortic valves insufhcieiit,
&c. (See further, “ Medical Post-mortem Records, Vol. 11, 18/7,

pp. 529-30.) t .

Extensive atheromatous degeneration of the thoracic and a Nomi-
nal aorta • in the latter, extending as low down as the origin
the superior mesenteric artery. That portion of the ^esse 1 wh. Or
lies between the diaphragm and creliac axis (in this instance
Lite two inches in length) is completely calcified, and forms a
hari ririd, unyielding tube. From an East Indian male, who
died from idiopathic tetanus. (“ Medical Post-mortem Records,
Vol III, 1879, pp. 301-2.)

SERIES VI.]

ATHEROMA OF PULMONARY ARTERY.

163

225. The heart of a patient who died in hospital from cerebral
meningitis, complicating malarious fever (malarial meningitis).
The inner surface of the pulmonary artery presents a series of
circumscribed, rounded, raised patches, lying just beneath the
lining membrane, which is smooth and entire. They are due
to atheromatous changes in the deeper layers of the intima, with
sub-epithelial proliferation of the connective tissue composing
the same.

226. Heart showing extensive endocarditis of the right chambers,
with fusiform dilatation and inflammatory thickening of the pul-
monary artery.

The heart is greatly" enlarged, especially its right cavities. These are
much dilated, the muscular tissue being, as it were, dissected out,
and, at the apex of the ventricle, and more or less throughout
the auricle,— thinned. The right auriculo -ventricular opening
admits five fingers. The tricuspid flaps are partially conjoined,
and their chordae tendinese thickened, so that the three portions
of this valve are not distinct. In the auricle, the opening of the
coronary sinus is large enough to admit the tip of the forefinger.
Both cavae (superior and inferior) are large and dilated. The
endocardium lining the right ventricle — especially over its
anterior wall — is enormously thickened, quite leathery in con-
sistency, rough, and corrugated. The pulmonary orifice is very
wide ; its valves malformed, and quite incompetent. The right
valve is thin and stretched ; the central valve has almost dis-
appeared. It forms a tightly -stretched, semi-transparent band
across the pulmonary orifice ; and the wall of this vessel (pulmo-
nary artery), immediately above it, is aneurisrnally dilated to the
size of half a walnut. The left valve lies on a lower level than
the other two, its left half thin and stretched, its right thickened,
flattened, and forming a prominent transverse ridge across the
pulmonary orifice. The pulmonary artery is extensively diseased,
its coats are thick and leathery, fully equalling those of the
normal aorta ; its inner surface is rough, opaque, irregularly
thickened, and forms an hour-glass-like dilatation, — a constriction
occurring about two inches above the pulmonary orifice, where
normally this vessel divides into its right and left branches.
The lower dilatation takes the form of a huge bulbar expansion,
measuring five and a half inches at its greatest transverse
diameter. The upper dilatation (i.e. above the constriction) is
rather smaller, measuring five inches transversely at the widest
part. The inner surface of this upper dilatation is greatly cor-
rugated or wrinkled. The foramen ovale is closed ; the ductus
arteriosus obliterated. The left cavities of the heart are small
in comparison with those of the right ; their muscular walls are
of about normal thickness. The mitral and aortic valves and
the lining membrane of the aorta show nothing abnormal in
their structure.

The aortic orifice does not seem to be unusually contracted, nor
the calibre of this vessel reduced. From the arch four branches
were given off. The right subclavian and right common carotid

1G4

DISEASES OF THE ARTERIES.

[sebies VI.

arteries, like the corresponding left vessels, took their origin
directly from the arch : there was no innominate artery.

This preparation was taken from the body of a Hindu, named Khettur,
aged 38, a blacksmith by occupation. He was admitted into
the College Hospital on the 6th April 1877, and died on the
15th of the same month. There was a history of both rheuma-
tism and syphilis (scar on penis, andrupial stains on the skin of
the neck, and over the left clavicle), and he had led an intem-
perate and debauched life ; was given to both opium-eating
and ganjah-smoking. Two years previous to admission, first
experienced pain in the chest, and began to suffer from cough
and dyspnoea. Palpitation and general anasarca of the body
only complained of and noticed within the last two months.

The patient was bloated-looking ; there was general anasarca (ascites,
&c). The area of the heart’s dulness much increased, the cardiac
impulse imperceptible, and the sounds of the heart feeble and
distant. A soft systolic bruit was heard at the apex, and con-
veyed a short distance to the left (not to the angle of the scapula).
No bruit at the base over aorta or pulmonary artery. The
jugulars were prominent, full, and pulsating. The conjunctivas
were jaundiced ; the urine high-coloured and scanty. Vesicular
respiration masked all over both lungs by loud sonorous and
sibilant sounds, and large moist crepitation at _ the bases
posteriori v. Decubitus dorsal. Complained of pain in the head,
giddiness," and a tendency to faint if standing erect or on
attempting to walk. Pulse very small and feeble.

The dyspnoea was relieved and the anasarca diminished during the
first week after admission. On the evening of the 14th, how-
ever, the former became more pronounced, hut during the night
subsided. On the morning of the 15th he was decidedly
better, but at 10 a.M. a sudden change seemed to have occurred—
probably increased effusion into the pericardium— and he died
very rapidly after a few gasping, ineffectual respirations. The
pericardial cavity was found, on post-mortem examination, to
contain nearly two pints of dark straw-coloured serum. The
heart with its covering occupied the whole of the space exposed
by removing the sternum, forming a mass the size of the adult
head. (See further, “Medical Post-mortem Records,” Vol. II,
1877, pp. 403-4.)

227. Calcification of the arteries of the right upper extremity.

998 The same condition of the vessels of the left upper extiemity

axillary, brachial, ulnar, radial, and anterior interosseous
arteries Both the above preparations were taken from a native
woman, aged about 40, who died from enkephaloid carcinoma of
the uterus Almost all the arteries of the body were similarly
affected.

229 Annular, and almost complete calcification of the arteries of t e
right lower extremity. The common, external, and internal lliacs,
the femoral and tibial arteries are represented.

230. A similar condition of the arteries of the left lower extremity.

SEBIES VI.]

CALCAREOUS DEGENERATION.

165

Both the above preparations were taken from the body of the same
patient as Nos. 227 and 228. ( See further also, “ Medical Post-

mortem Records,” Yol. I, 1873, pp. 288-89.)

231. The right and left femoral and anterior tibial arteries, showing
almost complete calcification, chiefly annular, but in parts quite
tubular in character. The coats of these vessels are very rigid
and friable. This condition was also met Avith in the posterior
tibials, in the spermatic and coronary arteries, but not in the
vessels of the upper extremities. From a European (male)
patient, who died in hospital from Morbus Brightii. ( See further,
“ Medical Post-mortem Records,” Vol. Ill, 1880, pp. 677-78.)

232. Calcareous degeneration of the mesenteric arteries, a few of which

have been dissected out and laid open to exhibit the altered
condition of their Avails. •

Taken from the same case as Nos. 227-230.

233. The abdominal aorta, from an inch above its bifurcation, Avith
the external, and the trunks of the internal iliac Aressels, the
right femoral Avith trunks of the profunda and popliteal arteries,
taken from a man Avho died from extensive gangrene, involving
the Avhole of the right leg and the lower third of the thigh.
“ The body was injected with dark-coloured injection, which
permeated all the vessels of the unaffected or left side. It also
entered the right internal iliac, Avhich Avas nearly twice the
size of the corresponding vessel on the opposite side. But no
injection passed into the external iliac of the affected side,
which, Avitli the femoral, profunda, and popliteal, Avere contract-
ed and cord-like to the touch. These vessels are opened,
displaying a cord of organized fibrin, extending their AArbole
length. This was firmly adherent to the lining membrane ; it
completely blocked up the vessels. A similar state of things
doubtless existed in the principal vessels of the leg ” (Ewart).

( Presented by Professor J. Fayrer.)

234. “ Enormous dilatation of the arch of the aorta. ******
The aorta is so much dilated at the summit of the arch as to
be equal to four fingers in breadth. It decreases again towards
each extremity of the arch, forming a sort of fusiform aneurism.
The internal coat is very extensively diseased, puckered, and
studded Avith cartilagenous, bony, and steatomatous deposits.
The left carotid and left subclavian are contracted by the
thickening of their coats. The pericardium Avas found univer-
sally adherent. From a European sailor, aged 34, who Avas
a very hard drinker, and died of dysentery.” (Webb’s Patholoyia
Indica, No. 754, p. 15.)

235. “ Aneurism of the ascending aorta, from a native. The sac of
the aneurism is opened. Its cavity is large enough to admit the
grasped hand. The dilatation begins from about an inch above
the semi-lunar valves, and extends to Avithin the first half of
the arch. The external portion is adherent to the internal
portion of the sternum, which, in one part, about as large as a
Avalnut, it has completely perforated. There is between the

166

DISEASES OF THE ARTERIES.

[series VI.

aneurismal cavity at this part and the integement only areolar
tissue, thickened and altered hy organized exudation. Some
relics of concentric layers of florin are seen on the wall of
the sac just underneath the portion of the sternum which has
been preserved ” ( Ewart). (Webb’s Patliologia Indica , No. 1674,
p. lv.) ( Presented by Dr. Oxley, of Singapore.)

236. Aneurism of the ascending portion of the arch of the aorta,

about the size of a small orange, originating immediately above
the coronary valves, which appear to be somewhat stretched,
but not otherwise abnormal. The aneurism has expanded
towards the left, its most projecting portion being directed
towards the left auricle, to the surface of which the sac is fiimly
adherent, and into the cavity of which it opens by means of a
smooth-margined orifice, admitting the tip of the little finger,
situated just below the fossa ovalis. The inner surface of
the sac, which appears to be formed by the dilatation of all the
coats of’ the aorta, is peculiarly puckered or wrinkled. It shows
no trace of any fibrinous deposit. _

The subject was a European seaman, lately arrived from England. He
died in hospital from pneumonia, about six weeks after admission.
(See further, Webb’s Patliologia Indica , No. 871, pp. 27 and 43.)
( Presented by Professor J. Jackson.)

237. Aneurismal dilatation of the ascending portion of the aorta,
with the formation of an aneurismal tumour at the outei and
superior aspect of the junction of the ascending and transverse
portions The tumour is about the size of a walnut ; it opens
into the general dilatation of the vessel by an orifice rather
iat*rror ftjui an eie-ht-anna piece, having a rounded, smooth

the neck it could only obey the law ot increase by insinuating
there a small secondary cyst. The neck of this secondary sac
ofill ko*r« marks of the constriction it had undergone. l,y its

SERIES VI.]

ANEURISMS OF ARCH OF AORTA.

167

oval-shaped orifice, an inch in length and half an inch wide. The
sac appears to have extended upwards to a point about midway
between the origin and bifurcation of the common carotid, and
here to have ruptured, the extravasated blood forming for
itself a second sac — the size of a hen’s egg — by the condensation
of the connective and other soft tissues at the root of the neck
around it. Thus, two aneurisms, one springing directly from the
arch, the other a “ diffuse aneurism,” are seen situated one
above the other, with a narrow neck between them, presenting
an hour-glass-like condition. (3) Two small aneurisms— each
about the size of a hazelnut, — project backwards directly from
the posterior wall of the aortic arch, one presenting just between
the right bifurcation of the pulmonary artery and right
bronchus ; the other impinging upon the left bronchus at the
division of the trachea. This little tumour is half-filled with
laminated coagulum. (4) Along the anterior wall of the arch are
three or four small, shallow, aneurismal dilatations of the coats
of this vessel.

The largest aneurism exhibits a considerable deposit of stratified fibrin
in its interior, especially along the inner and posterior wall. The
innominate, right subclavian, and right carotid arteries appear
to be almost completely obliterated ; the last is filled with
pretty firm coagulum as far as the point where it was ligatured
during life. Every portion of the lining membrane of the
aorta is thickened, rough, and in parts calcareous. A portion of
the anterior wall of the arch has been cut away in order to
show the origins of the various aneurisms above described.

1 Case of Mr. T., aged 42. The tumour, when first seen, was “ about the
size of a pigeon’s egg, situated at the right clavicle between the
two origins of the sterno-cleido-mastoid muscle.” It had all
the characters of an aneurism, and was diagnosed as involving
the root of the right common carotid artery, which it was
proposed to ligature, but apparently the operation was refused
by the patient. About a fortnight after, the latter having
“ exerted himself violently at the dockyard the whole of the
previous day, the tumour became increased to treble its former
size. Instead of being confined to the lower part of the neck,
it was as high as the thyroid cartilage, and pulsated with great
force; it was excessively tender to the touch, and the skin
over it was red and inflamed.” There was distressing dyspnoea
and restlessness, and the patient now expressed great anxiety
to have the operation performed. This was done the following
morning, a ligature being placed over the right common carotid
artery, “ about three-quarters of an inch below its bifurcation.”
There was no change in the size of the tumour after the opera-
tion, but the pulsation in it was evidently less distinct. After
a lapse of three days, no material alteration having taken place
in the aneurism, its pulsation, on the contrary, becoming stronger,
galvanism was resorted to, and the needles introduced “ at
different places,” on two successive days, with the result of pro-
ducing decided hardening of the tumour and considerable relief

1G8

DISEASES OF THE ARTERIES.

[series VI.

to the patient. About a week after, however, he died suddenly.
Having “ got off his couch, he attempted to walk across the
floor to one of his children, who was crying, he fell on his face,
and when he was raised (almost immediately) he was found to
be dead. He had not made the slighest struggle before expiring.
The tumour in the neck was much smaller, and the skin over
it loose and flabby, so that it was certain the aneurism had
burst internally.” (From notes by Professor R. O’Shaughnessy,
who presented the preparation to the museum. (See further,
Webb’s Pathologia Inclica , No. 254, pp. 5 and 8.)

239. An aneurism, about the size of the closed fist, springing from
the anterior superior aspect of the arch of the aorta, at the
junction of its ascending and transverse portions. ihe sac
extends from the clavicle to the fourth rib, “ making its way to
the outside of the chest by destroying its walls and bursting in
this direction. Its walls are whitish, consolidated, and smooth.
An attempt has been made to heal the breach in the sac by the
effusion of recent coagula. Aneurism of long, standing, heart
large, right ventricle enormously hypertrophied, left dilated,
covered by adherent pericardium.” (Webb’s Pathologia Indica ,

No. 378, p. 5.) .

“ When the preparation is examined from behind, the adhesion of the
sac to the inner wall of the chest is well demonstrated, So. is
the somewhat irregular sacculation of the aneurism. Viewing
it from in front, the jagged sac lined with recent lymph at the
point where rupture took place, the complete absorption of a
portion of the right side of the sternum, just below the stei no-
clavicular articulation, and of the corresponding two ribs are
beautifully illustrated” (Ewart).

Aneurism of the ascending portion of the aorta, springing from
its outer aspect, and attaining the size of a large orange. The
whole of the ascending portion of the arch is dilated, but the
transverse and descending portions are of about normal calibre.
“ The walls of the sac are about a sixth of an inch in thickness,
and uniformly lined with a thin lamina of organized fibrin.
The internal coat is destroyed, the parieties being made up of
the attenuated middle tunic and the greatly thickened cellular
coat. The heart is enormously hypertrophied, and the pericar-
dium greatly thickened and adherent by tolerably recent adhe-
sions(Ewart). The aneurism has progressed outwards to the
ri2ht, and also slightly backwards, the sac extending for about
two inches behind the transverse portion ol the aortic arch.
(Presented by Professor Allan Webb.)

“ Aneurism of the ascending aorta, with dilatation of the trans-
verse portion. A section of the sac is presented. The sternum
and ribs over it are preserved. The diameter of the sac from
above downwards is fully six inches, and diagonally or antero-
posteriorly four inches. The great bulk of the sac is projecting
towards the anterior port of the chest, to which it is seen to be
very firmly adherent. Its internal surface is very irregular, and

240.

241.

SERIES VI.] ANEURISMS OF ARCH OF AORTA.

169

in some places contains shreds of lymph ” ( P fihrin). “ From a
native.” (’Ewart). ( Presented by Professor S. B. Partridge.)

242. An aneurism, rather larger than a walnut, arising from the
outer aspect of the ascending portion of the arch of the aorta,
and extending outwards, backwards, and a little downwards,
finally opening into the pericardial cavity by a smooth-margined,
rounded orifice, sufficiently large to admit a crow-quill, situated
on the left side of the root of the aorta, just beneath the
reflection of the pericardial membrane. The orifice of communica-
tion of the aorta with the aneurism is smooth, rounded, and about
the size of a four-anna piece. The sac is partly filled with
coagulum. The right coronary artery may be traced along the
floor of the aneurism, and is apparently quite occluded. The
left coronary artery is of large size and distributed normally.
The two layers of pericardium were united irregularly by old
adhesions, and therefore their separation by the extravasation of
blood from the aneurism must have been gradual. ( Presented by
Dr. Evans.)

243. Aneurism of the ascending portion of the aorta, with general
dilatation of the transverse portion. An aneurismal tumour,
about the size of the closed hand, is seen projecting forwards and to
the right behind the sternum and first four ribs. The sac is
almost filled with stratified, firm fibrin. Anteriorly, it is very
thin, but laterally, thick from condensation of the surrounding
soft tissues, In the former situation it is seen to present in
the interspace between the second and third ribs, forming a
rounded prominence here, and leading to the absorption of these
two ribs, and a portion of the right margin of the sternum.
The reason for such an abundant filling-up of the tumour by
laminated fibrin appears to he that as the aneurism grew, it
came to press upon the aorta itself at its root, thereby narrowing
the aortic orifice, and causing a diversion of the current of blood
upwards and to the right, so as to dilate the transverse portion
of the arch, while comparatively a much smaller amount of
blood than in the normal state entered the ascending portion
and its aneurism. The whole of the aorta is highly athero-
matous.

i base of William Butler, an American (coloured) seaman, who “stated
that the disease originated from severe exertion in pulling some
ropes in a heavy squall at sea, about three months ago. He
felt at the time as if something gave way under the axilla.” He
was treated by rest, repeated leeching and morphia. Died from
dysentery about nine weeks after admission into hospital. (See
further, Webb’s Pcitliologia Indica, No. 671, pp. 5-6.) ( Presented
by Professor J. Jackson.)

k44. Aneurism ol the ascending portion of the aorta, rupturing into
the pericardium. The aneursim is about the size of a hen’s egg
arises from the intra-pericardial portion of the aorta, communi-
cating with its anterior wall by an orifice of irregular outline
the size of a four-anna piece. The sac projects forwards and
downwards, is intimately adherent to the reflected pericardium

170

DISEASES OF THE AETERIES.

[series vi.

above and in front, and is here thickened also by the deposit of
laminated coagulum upon its interior ; hut below, to the right
of the origin of the pulmonary artery, it is very thin, and at
this spot has ruptured into the pericardial cavity. The latter,
in the preparation, is seen tilled by a large coagulum of blood,
closely moulded to the heart’s surface. (No. 121, p. 28, Webb’s
lathologia Indie a.)

245. Aneurism of the arch of the aorta. No history. A tumour, as
large as the foetal head, consisting of a fusiform aneurismal
dilatation of the ascending and transverse portions of the aortic
arch. It ascends upwards into the neck as far as the lower
border of the thyroid cartilage, and by pressure upon the
trachea has induced perforation, — a minute opening, capable of
just admitting a thick bristle, being seen between the eighth and
ninth rings of the windpipe. The sac also projects anteriorly,
and had apparently contracted intimate and firm adhesions with
the first piece of the sternum, for an irregularly rounded and
ragged opening is observed on its anterior aspect, where a |
portion of its structure seems to have been torn away in removal.
The dilatation which affects the ascending portion of the arch
is separated by a slight constriction from that involving the
transverse portion, but essentially they are continuous, and all
the coats of the vessel participate in the fusilorm expansion
thus produced. The innominate is compressed and narrowed,
but not involved in the aneurism. The left carotid is com-
pletely plugged and impervious. The left subclavian large and
dilated. The orifice of origin of the former is seen at the upper
part of the sac ; the latter arises just beyond it. The whole of
the aneurism is lilted with coagulum ; that towards the periphery
is very firm and stratified.

246. “ Aneurism of the arch of the aorta, which burst externally

through the sternum.” The aneurism projects from the anterior
aspect of the sternum as a growth, the size of two fists, rounded
and broad at the base, conical towards the apex. A portion of
the integument has been left, showing the part where rupture
took place. The opening is about the size of an eight-anna
piece, and the skin here is very thin, ragged, and undermined.
The sac is very large, and has an hour-glass shape. That por-
tion within the thorax is the size of an orange, and projects
from the anterior aspect of the arch at the junction of the
ascending and transverse portions. It has a well-defined, cir-
cular orifice of communication (about two inches in diameter)
with the generally dilated arch. The portion extra-thoracic has
perforated the manubrium, about two inches below the episternal
notch, and to the right of the mesial line. The sac here has
become diffuse, i.e. is formed not only by the thinned, stretched,
and ruptured coats of the vessel, but also involves the subin-
tegumental connective tissues. The whole of this extra-thoracic
portion is filled with laminated fibrin, and the greater portion
also of the intra-thoracic expansion. No history.

series vi.] ANEURISMS OP ARCH OF AORTA.

171

[Glass rods have been placed in the preparation to show, I st, the orifice of
communication of the sac with the aorta, and the sacculated
character of the intra-thoracie portion of the aneurism ; and
2 nelly, the generally dilated and highly atheromatous condition of
the rest of the arch, — from which the brachio-cephalic vessels
arise.]

247. “ Aneurism of the ascending aorta, with hypertrophy and
dilatation of the left ventricle. The aneurism springs from the
anterior and right side of the aorta, immediately above the valves,
and extends downwards, forwards, and to the right towards the
right auricular appendix, which it touches. The heart has been
opened from behind, and the walls of the left ventricle are held
apart by a glass rod ” (Colies).

The aneurism is of the sacculated variety, and as large as a duck’s egg.
Its inner surface is rugose and highly atheromatous, and the
whole arch presents similar conditions. The sac is empty, —
contains no fibrinous deposit. The aortic valves arc inefficient,
thickened, and crumpled, the middle valve in particular.

248. “ Enormous aneurism springing from the arch of the aorta, close
to the origin of the arteria innominata. It communicates with
the aorta by an oval opening, nearly an inch and a half long bv
half an inch wide. The sac is bounded in front by the cartilages
of the ribs and the upper portion of the sternum. Tiie osseous
tissue of the latter has been completely absorbed in the centre,
nothing being left but the periosteum and fascia. The sac has
bulged up into the neck as far as the larynx, thrusting the thyroid
gland and trachea so far to the right side that the latter lies
behind the right subclavian artery. Both the right subclavian
and right carotid have been also thrust over to the right, so that
the latter lies to the outer side of the pneumogastric nerve,
while the internal mammary runs almost horizontally inwards
from the former to reach its proper place on the wall of the
chest.

The left ventricle of the heart and the posterior surface of the ascend-
ing aorta have been laid open. The sac has been opened on the
left side, and its walls kept apart with glass rods. The cervical
portion of the sac has been torn in two places” (Colles).

' 249. “ Large aneurismal dilatation of the ascending aorta, with

atheromatous degeneration of the arch and descending aorta.

1 he aorta is full of patches of calcareous degeneration, many of
which are as large as finger-nails. The ascending aorta, from its
origin to that of the arteria innominata, is dilated into a sac
capable of holding six or seven ounces of fluid. All the coats
are equally involved ; there is no tendency to “ point.” The sac
in its upper and right aspect, where the great aortic sinus would
be, contained a decolourized coagulum, now much shrunk
(retained in situ by a couple of stitches). This lay loose in
the. cavity : there was no laminated adherent coagulum. The
patient, a European, was admitted, 35 days before death, with
obscure symptoms, supposed to indicate hepatic abscess. * Some
small cicatrices were found in the liver” (Colies).

172

DISEASES OF THE ARTERIES.

[8ERIES VI.

250. Aneurism of the ascending portion of the arch of the aorta. The
sac is the size of a Tangerine orange, lies below, to the right, and
also a little in front of the innominate artery, which is not
involved. It is partially filled with laminated coagulum, and
formed chiefly by the outer or fibrous tunic of the aorta. The
whole of this vessel is diseased — atheromatous. “ Death took
place from rupture.” ( Presented by Dr. T. R. Lewis, Presidency
General Hospital.)

251. F usiform aneurism the size of a lanje pomegranate, implicating
the ascending and transverse portions of the arch of the aorta.
Death was caused by the sudden rupture of the sac into the
pericardium, at a spot situated about an inch and a half from the
root of the aorta, in the cul-de-sac formed by the visceral layer
of the pericardium on being reflected to form the parietal layer.
The aneurism contained some solidified, laminated, fibrinous
deposit towards its outer part, and a coagulum of semi -decolour-
ized blood, the size of a hen’s egg, was found loose in its cavity.
The whole of the lining membrane of the expanded arch is thick-
ened, rough, and in some parts tuberculated, and even calcareous
from atheromatous changes. At the superior and outer portion
of the aneurism the sac is thinnest, and was firmly adherent to
the under surface of the manubrium, where the bone was denuded
of periosteum and hollowed out to the depth of about a quarter
of an inch. At the anterior inferior boundary of the aneurism is
seen the rent through which it hurst into the pericardium. This
opening readily admits one finger, is oval in shape, its margins
ragged and thin. In the recent state, a small fresh clot was
found temporarily plugging it. The descending aorta is through-
out thickened by atheromatous deposit : the same condition
extended as low down as its bifurcation into the common iliacs.
About two inches below the origin of the left subclavian artery,
i.e. at the commencement of the descending aorta, a small, partial
dilatation of the vessel is seen. The aortic valves were fairly
healthy ; the inferior flap of the mitral slightly thickened The
left pneumogastric and recurrent laryngeal nerves were found
compressed and flattened ; the latter seemed to become lost on
the posterior surface of the sac. The left ventricle is hyper-
trophied.

252. Preparation exhibiting a large aneurism of the innominate artery
and arch of the aorta. During life, the tumour produced a
distinct prominence of the anterior wall of the thorax, at the first
right intercostal space, close to the upper part of the sternum ;
and, after death, the manubrium was found hollowed out into
a large cup-shaped cavity ; the hone denuded of periosteum, and
so much thinned as to be almost translucent. The aneurism
seems to have sprung from the junction of the ascending and
transverse portions of the aorta, and to have involved, more or
less Completely, the whole of the arch. The walls of the ascend-
ing portion are enormously thickened. The sac has also very
thick and dense walls, except where adherent to the chest wall
(anteriorly). The origins of the right common carotid and

series VI.] ANEURISMS OF ARCH OF AORTA.

173

subclavian arteries, as well as the whole of the innominate artery,
are involved in the aneurism ; the left carotid and subclavian
appear to be quite free. The right subclavian was found greatly
displaced backards, towards the spine. The inner surface of the
sac was lined by several superimposed layers of firm, decolour-
ized fibrin. The left bronchus is compressed, and the whole
of the left lung was found collapsed. The mucous membrane
of the trachea, about two inches above the point of bifurcation,
and to the right of the mesial line, is seen to present three small,
transverse, clean-edged ulcers, one above the other, exposing the
corresponding cartilagenous rings. The tumour seems to have
pressed considerably in this direction. The left ventricle of the
heart is hypertrophied. The aortic and mitral valves are slightly
thickened and opaque.

The specimen was taken from a Hindu, named Gokool, aged 40. He
had syphilis at about the age of 25, and was addicted to opium-
eating and ganjah-smoking. The alleged cause of the disease
was a severe strain received at the upper part of the chest, about
a year previous to his admission into hospital, while lifting a
heavy load of cloth on to his head.

There was an oval swelling, about three inches in diameter, situated
immediately beiow the clavicle, and encroaching upon the right
margin of the sternum. Pulsation was faintly visible, but
felt distinctly on palpation. This part was dull on percussion.
Hie heart’s impulse was strongly transmitted through it, but no
bruit was heard over the tumour, only a strong, rasping mur-
mer at the ensiform cartilage. The patient was much troubled
with a frequent metallic cough, but his voice was not affected.

253 Aneurism of the ascending portion of the arch of the aorta, the
size of a foetal head, directed downwards, backwards, and to the
right. It is distinctly sacculated, the orifice of communication
with the aorta being well defined, and marked by a rounded,
opaque, thick margin or lip about three inches in diameter.
The sac is lined by a large amount of dense, laminated fibrin;
such portions as remain uncovered exhibit a thickened, athero-
matous and even calcareous condition. There is Hso much
thickening of the sac externally by new growth of fibrous tissue,
in which were traced numerous, small, ramifying blood-vessels.
Ibe superior cava has been considerably compressed and dis-
placed downwards and backwards. The transverse portion of
the arch shows extensive atheromatous thickening and calci-
fication. I his is especially marked around the points of origin
of the large arteries springing from it. The mitral and aortic
valves are thickened and yellowish-white in appearance. The
left ventricle is hypertrophied. The external surface of the heart
loaded with fat.

254. Preparation showing a large sacculated aneurism of the arch
ot the aorta, situated at the junction of the ascending and
transverse portions. The heart and aorta, trachea and bronchi,
as also the whole of the middle lobe of the right lung (to which
the sac is ■ strongly adherent) are all preserved in situ. The

171

DISEASES OF THE ARTERIES.

[series VI.

aneurism is about the size of one’s fist, and occupied the greater
part of the anterior and middle mediastina. It filled the second
and third intercostal spaces, and was here adherent to the
costal cartilages and right half of the sternum. The heart was
displaced considerably downwards, and to the left. The whole
of the aorta is thickened, but especially its ascending and
transverse portions. At their junction, an orifice is seen,
somewhat larger than a rupee, with well-defined, abrupt,
thickened edges, leading into the aneurismal sac. lhe latter
is formed by the external tunic of the aorta only, but is much
thickened by adventitious adhesions from the surrounding tissues.
From its point of origin, it extended upwards and backwards
to the right. It also passed for a short distance behind the
arch, between it and the trachea, and here it is seen that the
right bronchus, close to the tracheal bifurcation, is much
flattened and compressed. The aneurism was found about half-
filled with coagulum, chiefly dark and soft. The innominate
artery is not involved ; it arises above and in front ol the sac ;
and for the same reason, the left common carotid and left sub-
clavian vessels are free and healthy looking. The pulmonary
' artery was firmly fixed to the aorta, and somewhat compressed.
The innominate veins and superior cava were also displaced and
compressed. The muscular tissue of the heart is exceedingly
soft and flabby.

The specimen was taken from a Hindu (Gopal), aged 35, who died in
hospital. (See further, “Medical Post-mortem Records,” Vol. II,
1870, pp. 283-84.)

255. A fusiform aneurism of the arch of the aorta, from a European,
aged 49, an indigo-planter. The ascending portion of the arch
is expanded so as to constitute a fusiform, true aneuiism, the
size of one’s fist. It was found filled with soft blood-coagulum,
and only at one spot, at the highest part of the aneurismal sac,
over a limited space, about the size of an eight-anna piece, was
there any attempt at the deposit and lamination of fibrin. The
entire inner surface of the arch is thickened, rough, corrugated,
aiM raised in smaller and larger, soft, opaque-white patches,
interspersed among which are a few small calcareous scales or
plates. The aneurism is constituted by all the coats of the
aorta. Its external surface is much thickened by adventitious
adhesions with the connective and other tissues in the anterior
mediastinum The orifices of origin of the vessels springing
from the arch are all a good deal thickened ; that of the innomi-
nate is also dilated to a considerable extent. A fourth branch,
the left vertebral artery, is seen to arise from the arch between
the left carotid and subclavian arteries. The left ventricle is
hypertrophied, its walls fully an inch in thickness. The endo-
cardium and valves are opaque 5 the aoiiic valves quite insulin n nt.
The right cavities are in a state of hypertrophic dilatation.
( See further, “Medical Post-mortem Records,” Vol. 11, 1877,
pp. 359-60.)

beeies VI.] ANEURISMS OF ARCH OF AORTA.

175

256. A preparation showing a fusiform aneurism of the arch of the
aorta, involving the ascending and transverse portions. “ it
occurred in a prisoner in the jail, who was admitted into the
hospital directly after his conviction with symptoms of chronic
bronchitis. It was noticed that his respiration was noisy, but
how far feigned and how far real could not be made out. Under
treatment he improved, but was suddenly found one morning
worse than ever. His respiration was more noisy, skin cold, and
the breathing short and hurried. It was diagnosed that he was
suffering from some obstruction in the air-passage, produced by
sudden supervention of oedema glottis, or some narrowing of
the windpipe at its upper part by acute laryngitis. Tracheotomy
offered the only chance of relief, and accordingly it was per-
formed. The man confessed to some relief, but still the noisy
respiration continued, and he gradually sank the next day. In the
post-mortem room an aneurism of the aorta was detected. The
dilatation was in the course of the vessel, and was even on all
sides. There was no diverticulum to speak of, and the contents
of the aneurism were fluid. There was no bruit with the heart’s
sounds. The > aneurism pressed upon the bifurcation of the
trachea, and flattened out the rings. Besides, the laryngeal
nerve will be seen descending behind the trachea, and the
recurrent branch very much compressed. The operation relieved
only the reflex symptoms, but the obstruction still continued.
There is a calcareous plate on the wall of the aneurism on the
point of softening, and would have communicated with the
trachea if the man had lived a few days longer. He was a
confirmed subject of syphilis, and had adhesion of the pericar-
dium to the heart, as well as of the lungs to the pleurae.”

IThe specimen consists, as above described, of a fusiform aneurism of
aortic arch. It is about the size of the closed fist. In the
windpipe (also preserved) may be seen (1) the opening made
by the operation of laryngo-tracheotomy,— just below the thy-
roid cartilage ; and (2) the point at the bifurcation of the
trachea where the aneurism so nearly gave way, — the sac here
being so thin as to have actually ruptured in mounting the
preparation. (Presented by Dr. Gr. C. Roy, Civil Surgeon, ^Beer-
bhoom.)

i:257. Aneurism of the aorta. The whole of the arch is
highly atheromatous, and covered with large opaque patches
and calcareous plates. The ascending portion is fusiformly
dilated. About an inch and a half above the aortic valves
(which are thickened, crumpled, and inefficient) is the orifice of
a sacculated aneurism, about the size of an eight-anna piece.
The sac is only partially, and for but a short distance beyond the
mouth, composed of all the coats of the aorta. It is the size
of a small orange and firmly adherent to the sternum, the
upper portion of which is hollowed out and greatly absorbed, so
that the aneurism projects beneath the soft parts on the anterior
aspect of the thorax, and here forms an ovoid tumour, the size
ol one’s fist. The skin and subcutaneous tissues are also much

176

DISEASES OF THE ARTERIES.

[series VI.

thinned from pressure, and at one spot (indicated by a glass rod)
have given way, the sac virtually rupturing externally, and
probably thus leading to a fatal termination. No history.

258. Triple aneurism of the aortic arch. The first is the size of half
a walnut, arises from the ascending portion, half an inch above
the coronary valves, and is contained within the aortic reflexion
of the pericardium. The sac is thin, formed chiefly by the
outer fibrous coat, and has given way at one spot (indicated by a
glass rod in the preparation), blood being extra vasated into the
pericardial cavity. This extravasation was probably slow, allow-
ing time for the pretty firm coagulation of the blood, which in
successive layers is seen surrounding the greater portion of the
heart, and is accurately moulded to its outline.

Above this is a second aneurism, or aneurismal dilatation of the arch,
at the root of the pulmonary artery, projecting forwards and to
the right.

Just below the origin of the left common carotid and subclavian
arteries is the third aneurism, well-defined, sacculated, springing
from the anterior aspect of the transverse portion of the arch.
It communicates with the latter by a smooth-margined, rounded
orifice, rather larger than an eight-anna piece. It is the size of a
small orange. The inner and middle coats of the aorta are
ruptured a little beyond the mouth of the sac, and the latter
is thus formed by the outer or fibrous coat only.

The inner surface of the whole of the aorta is greatly thickened aud
atheromatous. (Webb’s Pathologia Indica , No. 256, p. 5.)

259. General dilatation of the ascending portion of the arch of the
aorta with the formation of an aneurism, the size of a pigeon’s
egg, at the upper and back part of the arch, just below the origin
of the innominate artery. The sac is formed by all the coats of
the vessel. Its mouth is rounded and about the size of an
eight-anna piece. It projects backwards and to the left, imping-
ing upon the trachea, to which it is firmly united, and bulges
into the interspace between the trachea and the left common
carotid artery. The trachea, about two inches above its bifurca-
tion, is perforated by the aneurism, — an opening capable of admit-
ting a crow-quill, with sharp, clean-cut edges (indicated by a glass
rod). A fatal termination was thus induced. The sac is half
full of coagulum. The innominate artery is greatly dilated,
and so also are the right subclavian and right common carotid.
The lining membrane of the innominate is thick and athero-
matous ] at one spot dilated so as to form a little aneurism, the
size of ’ a hazelnut, directed towards the median line. The
left common carotid is a good deal narrowed at its origin ;
the left subclavian wide and dilated throughout. Between
these two a small artery is seen, arising directly from the arch,
and of about the calibre of an ordinary radial. It is probably

the left vertebral. # . ,

260 A peculiar sausage-shaped aneurismal dilatation of the arch of the
aorta. The anterior portion forms a sacculated aneurism project-
ing forwards, and intimately adherent to the manubrium opposite

SERIES VI.]

ANEURISMS OF ARCH OF AORTA.

177

the articulation of the first rib. The sac here is very thin, and
constituted by the 'external coat only, the inner and middle
being found ruptured just beyond the mouth of the aneurism,
which is rounded and about in inch an diameter. The posterior
dilatation is a fusiform expansion of all the coats of the vessel,
reaching backwards so as to impinge upon the left side of the
dorsal vetebrae, to which it is adherent. A portion of the left
lung is also seen to have intimate connections with the sac.

261. “ Aneurism of the arch of the aorta of a European male,

opening into the oesophagus at the point now marked by a black
glass rod.” The aneurism is about the size of a walnut,
flattened from before backwards. In arises from the upper
and back part of the transverse portion of the arch, immediately'
below the origin of the left subclavian artery. Its orifice of
communication with the aorta is rounded, but rough, and rather
larger than a four-anna piece. The inner and middle coats
have given w'ay just beyond the mouth, the sac being formed
by the external fibrous tunic only. It is partially filled with
firm laminated fibrin. The whole of the ascending and transverse
portion of the arch exhibit fusiform dilatation and atheromatous
thickening of the walls. The left subclavian artery is compressed
and narrowed. The trachea, half an inch above its bifurcation,
shows the same condition, and, at one point, indicated byr a red
glass rod, exhibits thinning and commencing disintegration of the
mucous membrane from pressure of the aneurism.

“ Death did not result from haemorrhage, although a little blood was
spat up, but from pressure upon the trachea, and consequent
suffocation. The fatal attack of asphyrxia was precipitated by
a drinking-bout.” ( Presented by Professor Norman Chevers.)

:262. “ Dilatation of the ascending aorta, and aneurism of the trans-

verse portion of the arch, springing from each side of the arteria
innominata. The sac is directed upwards and forwards, is
firmly adherent to the parts at the root of the neck and the
interior aspect of the sterno-clavicular articulations, at which
points the pressure from within has led to absorption of the
osseous and soft structures, allowing the emergence of the
aneurism, and the formation of a pulsating tumour in this
situation” (Ewart). ( Presented by Professor li. O’Sham-h-

“essy-> .

9263. “ Aneurism of the aorta. The aneurismal sac is seen springing
from the transverse portion of the arch ; in shape it bears a
strong resemblance to a small heart. It occupies the anterior
mediastinum, its base being on a level with the upper border of
the sternum, its apex corresponding with the upper border of
the third rib, keeping the centre of the sternum. It appears to
be of old standing, the walls are thick, firm, and white. No
thinning of the bone seems to have taken place, and the dysen-
tery of which the man died has so reduced him as to admit of
the sac being filled with firm coagula of blood, excepting a small
part of the centre. The descending portion of the aorta, and
ascending portion also, are partially obstructed with coagula

178

DISEASES OF THE ARTERIES.

[series VI.

the innominata, its branches, and left carotid, are completely-
closed, an affort having been made, during the existence of this
low state of the system, for the entire cure of the aneurism by
plugging up the principal vessels in the neighbourhood with
coagula (Brasdor’s principle). From a European seaman, aged
40,” admitted into hospital on the 3rd July 1842, and who died
from dysentery on the 5th September following. The aneurism
is the size of an orange, and springs, strictly speaking, at. the
point of junction of the ascending and transverse portions of
the aorta, involving both. Its interior is filled almost complete-
ly with firm, decolourized, stratified coagulum. At the central
part a hollow is left, which can be distinctly traced to a tunnelling
of the clot in the aneurism by the stream from the aorta, so
that practically the tumour itself was quite consolidated. The
plugging of the innominate, right and left carotid arteries, and
right subclavian is well seen. ( See further, Allan Webb’s Patho-
locjia Indica , No. G58, pp. 4 and 10.) (Presented by Prolessor
J. Jackson.)

264. An aneurism of the transverse portion of the arch of the aorta,
about the size of a duck’s egg. It involves the anterior wall
and floor of the aorta ; in the latter situation, it is seen to have
burrowed to the right by separating the internal and middle
from the outer fibrous tunic, and has thus reached the ascending
portion of the arch, into which, however, it does not open. The
walls of the aneurism are everywhere thin, corrugated, and
formed by the external or fibrous coat only, slightly thickened
anteriorly by condensation and adhesion of the loose connective
tissue of the anterior mediastinum. The sac lies immediately
above the pulmonary artery, the right division of which is
much compressed, while the left compensates, by dilatation to
more than twice its normal size. The mouth of the aneurismal
tumour is wide and irregular. ( Presented by Dr. Mouat, In-
spector-General, Madras.)

265. Aneurism of the transverse portion of the arch of the aorta.
A globular tumour, as large as a man’s fist, projects from the
anterior and upper wall of the aorta. The sac, which is laid
open, is completely filled with laminated coagulum ; it com-
municates with the aorta by a rounded orifice, two inches in
diameter. At the back part of the preparation wili be seen
another small aneurism of the innominate, close to its origin,
the size of half a walnut, projecting outwards and backwards
so as to flatten and compress the right bronchus. This little
aneurism, as well as the rest of the innominate, is filled with firm
decolourized coagulum. The left carotid artery is completely obli-
terated, converted into a firm, compact, fibrous cord. The left
subclavian is pervious and dilated. The descending portion of
the arch is very greatly dilated, all its coats much thickened and
tough ; the lining membrane rough and atheromatous. The
left pneumogastric nerve is seen crossing the front of the
aneurism,— considerably flattened. No history. ( Presented by
Dr. John Macpherson.)

i sebies vi.] ANEURISMS OF ARCH OF AORTA. 179

266. “ Enormous aneurism of the transverse and descending portions

of the arch of the aorta, from a subject in the dissecting-room,
supposed to be about 40 years of age. The aneurism is fully
three times as large as the heart. It involves the whole of the
arch, and the vessels arising therefrom spring directly from the sac,
which is laid open in one part and seen filled with coagulum.”
(Ewart.)

1 267- A preparation showing (1) aneurismal dilatation of the whole
of the arch of the aorta, resulting in a fusiform tumour, which
involves the transverse and descending portions of the same.
Its extension is principally forwards and downwards. In the latter
situation it presses upon the root of the left lung, and (as will
be seen on the posterior aspect of the preparation) has ulcerated
into the left bronchus, the opening being small, with a smooth
rounded margin, and plugged by a minute coagulum. (2)
'there is an aneurism of the root of the innominate, the size of
half a walnut, projecting forwards and outwards to the right.
It is formed by the external and middle coats only, and contains
a small amount of stratified coagulum. No history. (Presented
by Dr. Scriven.)

268. “Aneurism of the arch of the aorta, its size equalling that
of a child’s head ” (Ewart).

The aneurism consists of a fusiform dilatation of the whole of the
transverse portion of the arch, commencing immediately beyond
the origin of the innominate artery. This vessel is elongated,
its coats thickened, and channel abnormally widened. The left
subclavian and left carotid arise directly from the upper part of
the sac. The latter has very firm, thick, leathery walls, which
are lined by a layer of dense laminated fibrin, fully half an inch
in thickness, and the whole sac is seen filled with decolourized
coagulum. The aneurism has extended forwards, downwards,
and slightly backwards (to the left). A portion of the anterior
margin of the left lung is seen firmly adherent to it. Poste-
riorly it has contracted inseparable connections with the trachea
and left bronchus, the latter being greatly flattened, its mucous
membfane thinned, and apparently at one spot ulcerated, a
communication with the sac being thus established, as indicated
by a glass rod in the preparation. The ascending portion of
the aorta is widely dilated and atheromatous. (The right ven-
tricle has been cut away.) No history.

1269. Aneurism of the arch of the aorta, which proved mortal by
bursting into the left bronchus. The opening into the air-
passage is as large as a four-anna piece, and is indicated by the
presence of a glass rod. .The tumour occupies the whole of the
transverse part of the arch. The innominata, the left carotid,
subclavian, and the thoracic aorta, spring directly from the sac ”
(Ewart).

870. “ Heart, great vessels, trachea, and larynx of a Greek, admitted
with what appeared to be laryngitis. A few days after admission
death by apnoea became so imminent that Dr. Chevers opened
the larynx in the crico-thyroid space (dividing the cricoid

180

DISEASES OF THE ARTERIES.

[series VI.

cartilage also), not being able to reach the trachea from the
shortness and fatness of the neck. The patient died on the
spot.

There is an aneurism, capable of holding upwards of a fluid ounce,
springing from the back of the transverse part of the aortic
arch. It extends upwards about two inches, and rests upon the
left bronchus, into which it was rapidly making its way. A
nipple-like protrusion can be seen in the anterior wall of the
bronchus, consisting merely of greatly thickened mucous mem-
brane, which must soon have given way. The walls of the
aneurism are lined with a thin layer of coagulum, of which
there is a larger mass on the side next the bronchus. There
is no arteria innominata. The two carotids rise by a com-
mon trunk in front of the aneurism. The left subclavian
rises next, and lastly, the right subclavian (cut short off), which
ran across behind the oesophagus. Hence the right inferior
laryngeal nerve was not recurrent , but must have run through
from its origin high in the neck to the larynx. There is no trace
of it to be seen in the part of the right pneumogastric, which
has been preserved. The left pneumogastric and recurrent
laryngeal nerves are normal. The cricoid cartilage is ossified, but
the larynx is otherwise healthy. The heart is flabby, and presents
several patches of fatty degeneration. Both it and the great
vessels were deeply imbedded in adipose tissue ” (CollesJ.
( Presented ly Professor Norman Chevers.)

270a. A sacculated aneurism of the arch of the aorta, projecting back-
wards from its transverse portion. The sac is about the size
of a walnut, is intimately adherent to the front ol the trachea
about half an inch above its bifurcation, and at this part two
or three adjoining cartilagenous rings have been separated from
each other, and the intervening mucous membrane presents two
small ulcerations or fissures, which are seen to be blocked with
minute blood-coagula. The anterior tracheal wall is indented
inwards from the pressure of the aneurismal tumour, and the
calibre of the tube is thereby considerably lessened. The mouth
of the sac measures about an inch transversely, and half an inch
in its longitudinal diameter. The projection of the aneurism
is abrupt. The whole of the arch of the aorta shows fusiform
dilatation, and the lining membrane is throughout highly
atheromatous and thickened.

The specimen was taken from a European, aged 44, admitted into the
General Hospital with left hemiplegia.

The heart (not preserved) was found 1 ealthy, and nothing remarkable
discovered in the brain, except “ serous distension of the right
lateral ventricle, and traces of old inflammation about the

medulla.” , .. J , ... ,,

“No symptoms relative to the aortic lesion were manifested until tne

last two months of life, when the patient began to suffer from
repeated and severe attacks of dyspnoea. At this time also
dulness over a limited space at the top of the sternum, Wit
slight impulse at the episterual notch and fulness of the jugular

SERIES VI.]

ANEURISMS OF ARCH OF AORTA.

1S1

veins were observed.” ( Presented by Dr. E. Lawrie, Presidency
General Hospital, Calcutta.)

' 271. “ Aneurism of the descending portion of the aorta : an aneurismal

dilatation exists also at the ascending portion. The thickened
and diseased state of the lining membrane is well shown. The
sac is large and empty : to this is attached a secondary sac, the
size of a walnut, which has given way by ulceration. The mode
in which it destroyed life, by bursting into the oesophagus, is
beautifully shown. Hypertrophy of the left ventricle enormous.”
(Allen Webb, Pathologia Indica, No. 251, p. 5.)

:272. Aneurism of tbe descending portion of the arch of the aorta, about
the size of an orange, communicating with the vessel by a wide
mouth, and assuming an ovoid shape. The internal and middle
coats have given way a short distance beyond the orifice of the
sac, the external coat alone forms the same. It is said to have
ruptured and thus produced death. A good deal of laminated
coagulum fills the sac. (Webb’s Patliologia Indica , No. 743,
p. G.)

:273. “ Aneurism of the arch of the aorta, just beyond the origin of

the left subclavian. It is of an elongated form, and would
almost hold a hen’s egg. It is partly lined with lami-
nated coagulum. It is adherent below and externally to the
top of the left lung, into which it burst, causing instantaneous
death. The rent in the lower part of the sac can be seen. The
patient, a gentleman aged 35, had had a slight cough for some
years, but was otherwise healthy, and the disease was never
suspected. He felt sick a few minutes before the fatal
haemorrhage took place” (Colics). ( Presented by Professor
J. Fayrer.)

'574. “ Aneurisms of thoracic aorta, the upper of which caused death

by bursting into the oesophagus. Case of Private Scott, Her
Majesty’s 94th Foot; admitted into the hospital of the
Kussowli Convalescent Depot on the 27th February I860,
with a violent hsematemesis. The blood, of which he discharged
upwards of a quart on the night of the 26th, was dark coloured,
and not in the least frothy. He was treated with turpentine
and gallic acid. The haemorrhage ceased next day, but returned
on the 28th, on the patient sitting up, and proved instantly
fatal. The left ventricle is in a state of bitty degeneration, and
patches of atheromatous deposit are seen in the aorta, particu-
larly in its arch and descending and thoracic portions. The
valves are healthy (as shown at the back of the specimen).
The aneurismal sac begins just beyond the origin of the left
subclavian artery, by a small opening, the size of a silver two-
anna (three-penny) piece. The sac is shaped like a small auri-
cular appendix, and extends backwards from the aorta, opening
into the oesophagus by a breach as large as a shilling (marked
by a cross of black glass rods). The edges of the aperture are
tolerably smooth and everted ; it must have existed for some
time before death. The cavity of the aneurism is filled with
firm coagulum, by which both the opening into the ^ aorta and

182

DISEASES OF THE ARTERIES.

SEEIE8 VI.

that into the oesophagus are to a great extent blocked up (a red
glass rod has been passed from the aorta horizontally through
the sac into the oesophagus). The posterior wall of the aneurism
is very thin, and has in fact given way in one part (marked
by a black glass rod), so that, had the patient lived much longer,
blood would have been effused into the posterior mediastinum.
The upper part of the oesophagus in the vicinity of the aneur-
ismal aperture is blocked by a firm coagulum ; the lower part
has been stuffed with cotton, and a blue ' glass rod passed
through it. About four inches below tins aneurism is a second
smaller one, which has evidently begun at the centre of an athero-
matous patch. It has been filled with cotton-wool, and its
mouth kept open by two bits of ulass rod, placed at right
angles. Its cavity was devoid of coagulum, and would, when
recent, have held a hazelnut.” ( Presented and described by
Dr. .1. A. P. Colles.)

275. A large aneurism of the descending portion of the arch of the
aorta. “ The sac now spread out measures ten inches in length.”
It was found occupied by a very large mass of firm coagulum.
It has apparently pressed backwards upon the trachea, which,
in the preparation, is seen to be flattened, and, at the site of its
bifurcation, the mucous membrane presents superficial ulceration
or erosion. The whole of the aorta is diseased, its inner surface
irregular, thickened, and rough from atheromatous changes.
The aortic valves are stretched. The left ventricle dilated.
( Presented by Dr. Mackenzie, General Hospital.)

276. A preparation showing ( 1) a large aneurismal sac, the size of
an orange, arising from the descending portion of the aortic
arch, and pressing backwards and upwards towards the left.
In the recent state, the superior lobe of the left lung was found
firmly united to the sac, and the latter pressed upon the
trachea near its bifurcation, particularly upon the left bron-
chus, rupture into which was the cause of death. (2) A second
aneurism, rather smaller than the preceding, is seen below it,
lying close to, and intimately connected with the sixth and
seventh dorsal vertebrae and their adjacent articulating ribs.
It arises from the thoracic aorta beyond the arch. The aorta
between these two aneurisms is rather dilated, and its walls
much thickened, but is still tubular, and hence a kind of hour-
glass shape is presented by the vessel with its upper and lower
aneurismal expansions. Both sacs are filled with a good deal
of laminated coagulum. The lung-substance in contact with
the superior and larger aneurism was found greatly compressed
and carnified. The vertebrae and ribs associated with the smaller
sac are eroded and carious. In both, the aortic tunics are defi-
cient. The oesophagus is said to have escaped pressure.

The patient, Anthony Matthew, an East Indian, aged 40, by occupa-
tion a cook, was admitted into hospital on the 30th of July
18G9, and died on the 9th of the following September. “ He
had suffered from cough and spitting of blood for the last five
months, and was treated in the General Hospital for pneumonia,

SBBIES VI.]

ANEURISMS OF ARCH OF AORTA.

183

for lie had extreme dulness in the left mammary and infra-
clavicular regions, and complained of pain in this part
of his chest.” The nature of the case was diagnosed by
Dr. Chuckerbutty, under whom the man was admitted in this
hospital — “ a pulsating tumour, with distinct aneurismal bruit.”
* * * * “ He died somewhat suddenly after

expectorating several pints of blood, the aneurism having
ruptured into the left bronchus.” ( Presented by Professor
S. C. Chuckerbutty.)

277- Aneurismal dilatation of the whole of the aorta, immediately
beyond the lef t subclavian artery, constituting a flattened tumour,
the size of a small orange, which was found firmly adherent to
the apex of the left side of the thorax, rising a little into the neck,
and united to all the soft parts here situated, as well as to the first
rib and clavicle. It lay immediately to the left of the bifurca-
tion of the trachea, and over the left bronchus, which appeared
to be slightly compressed fiy it. The aneurismal sac is much
thinned where adherent posteriorly as above described, so much
so, that it was torn on removal. It communicates with the
aorta by a very large oval-shaped orifice, and is almost filled
with firm, organized, and laminated coagulum. The left
pneumogastric nerve was found to descend immediately over the
front of the aneurismal sac, and the recurrent laryngeal passed
upwards between its posterior surface and the trachea, closely
adherent to the former, and distinctly thickened. Below the
aneurism the lining membrane of the aorta is highly atheroma-
tous, but this condition did not extend below the diaphragm.
On the proximal side of the aneurism the aorta is dilated. The
origins of the vessels from the transverse portion of the arch are
narrowed, that of the left subclavian is completely occluded. A
fourth branch, the left vertebral, arises between the left subclavian
and left carotid.

'This specimen was taken from a Mahomedan, aged 35, who was
admitted into hospital with great laryngeal dyspnoea, threaten-
ing imminent suttocation. Laryngo-tracheotomy was at once
performed, it being suspected that oedema of the glottis or acute
laryngitis existed. The man survived the operation for fortv-
eight hours, experiencing some relief to the breathing. He
died from acute hypostatic congestion and oedema of the lungs.
Ihe larynx was found healthy, but this aneurismal tumour was
discovered on post-mortem examination. ( See further, “ Surgical

i Post-mortem Records,” Vol. I, 1880, pp. 723-24.)

B278- “ Aneurism of the thoracic aorta in a native of China, forming
a pulsating tumour on the man’s back. The whole of the
thoracic and a portion of the abdominal aorta, the sac of the
tumour, a portion of the spine, and a couple of ribs are in situ."
The sac is firmly adherent to the left side of the bodies of five
dorsal vertebra), which are partially absorbed and hollowed out.
“ The bulk of the sac, however, has been directed against the
ribs, near their vertebral articulations, causing complete absorp-
tion of a couple of inches of one, and partial disintegration of

181

DISEASES OF THE ARTERIES.

[series VI.

about an inch of the inferior margin of another. The
opening of the aneurism here is fully an inch and a half in
diameter, and the parieties, which are reflected, are attenuated,
and more or less lined with coagulated fibrin. The distance
from the spinous processes of the vertebrae to the wall of the
aneurism, at the point of emergence from the chest, is about an
inch. There is a ragged opening in the sac, close to the upper
rib, which probably indicates the seat of rupture just prior to
death. Here the sac is exceedingly patulous and attenuated,
which has been partially compensated for by the deposition of
laminated fibrin within, and of inflammatory adhesions without”
(Ewart). The aneurismal sac probably equalled, during life,
the size of the foetal head ; even now, in its collapsed state, it
measures seven inches transversely, and seven and a half inches
in the longitudinal diameter. The aorta below the aneurism
is considerably reduced in size (Webb’s Pathologic, Indica ,
No. 1607, p. lv). ( Presented by Dr. J. A. Ratton.)

279. “ Aneurism of the thoracic aorta, proving fatal by rupture and
hsemorrhage into the oesophagus. The large opening from the
aorta into the sac is about an inch and a half by one. The
aneurism is about the size of an orange, and is bound down to
the lung and oesophagus, which it has perforated about an inch
from the entrance of the tube into the diaphragm. The edges
of this opening are everted and somewhat ragged. A coagulum
is seen indicating Nature’s attempt to plug the orifice and to
prevent the fatal result- The opening in the oesophagus is
circular, and about three-quarters of an inch in diameter. There
are three other small aneurisms in the aorta, close to the large one
just described, all of which have • smooth-margined communi-
cations with that vessel.

The subject was an asthmatic Hindu, a native of Kumaon, aged about
52, whose body was picked up on the banks of one of the rivers
near Almorah, and was examined to ascertain the apparent
cause of death” (Ewart). The above-described aneurism was
discovered “ opening into the oesophagus, about an inch above the
diaphragm, and the stomach was enormously distended with
grumous coagulated blood.” ( Presented by Moulvie Tameez
Khan, Khan Bahadur.)

280. “ Aneurism of the thoracic aorta commencing just below the
origin of the seventh pair of intercostal arteries, extending along
three inches of the vessel, and situated on the bodies of the
eleventh and twelfth dorsal vertebra}, which are much eroded,
leaving their cartilages unaffected. The sac was firmly adherent
to the crura of the diaphragm. It had given way by a small
opening on the right side, close to the spinal column, into the
right pleural cavity” (Ewart).

The aneurism is about the size of an orange, projects forwards and to the
right from the thoracic aorta just above the diaphragm, to which
the inferior and anterior aspects of the sac are closely adherent.
The abdominal aorta is reduced in size.

secies vi.] ANEURISMS OF THORACIC AORTA.

185

231. “ Aneurism of the thoracic aorta, pressing upon and causing

caries of the bodies of ten dorsal vertebrae. The body of one
below has been completely absorbed down to the dura mater,
and still higher a portion of the body of another vertebra is
disintegrated down to the same tunic. The large sac, now rather
torn from being detached from the spine, is turned aside to
display the damage done to the spinal column. It is filled with
a very dense, coarsely laminated coagulum. In one spot the sac
was about to open into the left lung.

The patient was an elderly American seaman, who became perfectly
paraplegic only a few days before death. After having lest all
power of sensibility in his lower extremities, he declared that
on one occasion, during the night, he found himself able to
use his legs. The truth of this appears possible considering the
manner in which the spinal cord was compressed by the tumour,
whose volume was liable to be diminished from the quiet state
of the circulation during sleep ” (Ewart). There is great general
dilatation of the whole of the arch of the aorta.

282. “ Aneurism of the commencement of the thoracic aorta. It has
three sacculated divisions, the largest of which has opened into
the left bronchus. Behind, the bronchus is held open, exposing
a square orifice possessing jagged and irregular edges. This
opening is partially plugged by coagulum ” (Ewart).

The aneurism is about the size of a hen’s egg. Its orifice of communi-
cation with the aorta is 2^ by 1^ inches in diameter, the margins
smooth and rounded. The uppermost “ sacculated division ” of
the sac encroaches upon the arch. It will be noticed in
this preparation that the four brachio-cephalic vessels arise
separately and independently from the arch of the aorta : there is
no innominate artery.

Aneurism of the thoracic aorta, the size of a- foetal head. The
sac lies to the left front of the second, third, fourth, fifth, and
sixth dorsal vertebrae, and has produced considerable displacement
of the surrounding parts. The aorta is greatly diseased. Large
patches of atheromatous thickening, — some hard and cartilagen-
ous-like, others brittle and distinctly calcareous, all irregular in
outline and varying in size— stud the inner surface. This condi-
tion is well marked throughout the arch, but especially so in the
descending portion and thoracic aorta. The aneurismal dilatation
commences abruptly at the junction of the descending with the
thoracic aorta. The mouth of the sac has a diameter of two
inches in either direction, and a very distinct, rounded, raised, and
thickened margin is seen where this communicates with the main
vessel. The dilatation is chiefly to the left and backwards
against the spine, but the sac extends also upwards and across
the dorsal vertebra?.

11 he left bronchus has been much compressed and narrowed, is only a
little larger than a crow-quill ; the right bronchus, on the contrary,
measures fully an inch in diameter, and its membranous portion
has evidently been stretched. The oesophagus has been so much
displaced that it lies to the front of the spine, and to the right of

'283.

ISO

DISEASES OF THE AKTERIES.

[SEMES VI.

the aneurismal sac, and is much compressed between them at fhe
level of the fourth dorsal vertebra. The bodies of all the vertebrae
upon which the aneurism rests are deeply eroded and carious.
The sac of the aneurism is thick and firm in all directions
except towards the left, where it is almost diaphenous, and
presents two small slits, probably produced in attempting to
remove the tumour ’post-mortem . The preparation was taken
from the body of a European, aged 36, a ship’s steward. “ lie
denied syphilis, but cicatrices were found in both groins. The
disease had commenced apparently about two years previous to
his admission into the General Hospital,” but he had continued
to do his work, and his general health remained good. During
the last two and a half months only, had he suffered from “ attacks
of dyspnoea, constant cough, great pain in the back and left side,
difficulty in swallowing solid food, and inability to lie in any other
position than on the right side.” The left ribs and clavicle
bulged a little, and there was an irregular impulse in the third
intercostal space. No cardiac bruit of any kind could be

detected, and no lesions were found in the heart itself after
death. (Presented by Dr. Edward Lawrie, General Hospital,
Calcutta.)

284. A large aneurism of the thoracic aorta, which ruptured into
the left pleura. Its orifice of communication with the aorta is
about two inches below the origin of the left subclavian
artery. It is oval in shape, about two by one-and-a-half inches
in diameter, the margins rounded and slightly roughened. The
sac extends a little to the right, from the lower margin of the
third to the ninth dorsal vertebra, being adherent to the same
and to their right costal articulations. The expansion is,
however, chiefly to the left of the spine. Here, the sac is the size
of a large orange, and its walls are thin. It lies upon the sixth,
seventh, eighth, and ninth ribs, at their spinal articulations. The
outline is fusiform. The bodies of the fourth to eighth dorsal
vertebrae are deeply eroded, the anterior common ligament
completely destroyed, the bone rough and bare. The inter-
vertebral cartilages are prominent, and also superficially
ulcerated. Between the seventh and eighth ribs, about an inch
from the spine, the aneurism is seen to make its way backwards,
and presented externally beneath the integuments as a smooth
rounded tumour, the size of a small orange. About one-half
of the seventh and eighth ribs is here destroyed, the bone rough
and carious. The portion of the aneurism lying to the right of
the spine contains a good deal of laminated coagulum, but the
rest, except the protrusion to the back, contained fluid blood
only. The inner surface is rough and atheromatous, in parts
calcareous. The sac is thick and apparently composed of all the
coats of the aorta to the right of the spine, but on the left,
becomes gradually thinned towards the ribs. The rupture took
place on this side, at the upper part of the sac, immediately in
front of the sixth rib, about an inch from the spine. The rent
is about two inches wide, its margin, ragged and thin. The

series vi.] ANEURISMS OF THORACIC AORTA.

187

portion of the sac which protrudes backwards is also very thin,
the boundaries being chiefly composed by the muscles of the
hack. The spinal cord and its membranes remain entire, and
have not been exposed. The left pleural cavity was found filled
with large, dark, soft coagula and bloody serum. The left
lung was floated forwards, but adherent to the sac of the
anuerism posteriorly. The oesophagus was pushed considerably
to the right. The root of the right lung adhered to that
portion of the aneurismal tumour which extended across to this
side. The patient, a native male, aged about 28, stated
that he had been troubled with severe pain in the left side of
the chest, — especially at the hack, near the angle of the scapula, —
for the last two years. Only two months ago became aware of
a small swelling at this painful spot. This swelling, on his
admission, was distinctly pulsatile, situated between the spine
and the vertebral border of the scapula. No bruit could be
heard over it, and there were no murmurs with the heart’s
sounds. There was no history of strain or injury, or of syphilis,
&c. He died suddenly. (See further, “ Medical Post-mortem
Records,” Vol. I, 1875, pp. (501-62.)

285. Highly atheromatous aorta, with perforation of the left bronchus,
by rupture of a small aneurism. The ascending portion of the
arch and the innominate artery are fusiformly dilated. At the
junction of the descending portion of the arch with the thoracic
aorta is a puckered, depressed orifice, leading into a sacculated
aneurism, the size of a nutmeg ; directed backwards and to the
left, so as to overlie the left bronchus, to which it has become
firmly adherent. The sac appears to be formed by an expansion
of all the coats of the aorta. No laminated fibrin, nor any
coagulum was found in its interior. The orifice in the aorta will
admit a goose-quill. The sac has ruptured (ulcerated; into the
left bronchus, half an inch below the bifurcation of the trachea,
at a spot where the membranous portion of the bronchus
unites its fifth, sixth, and seventh cartilagenous rings. The
little tumour protrudes so far into the bronchus that the latter
must have been almost occluded. From a European seaman,
aged T9. Death was sudden from profuse . haemorrhage.
(Presented by Dr. S. C. Mackenzie, General Hospital, Calcutta.)

286- “ The sac of an aneurism of the abdominal aorta, about four
inches above the bifurcation. The orifice leading to it is as
large as a shilling, possessing smooth edges. The aneurism is
about the size of a small orange, and its interior is partially lined
with coagulum ” (Ewart). The sac is formed by the external
coat only. It seems to have been intimately connected with the
mesentery and small intestine. ( Presented by Dr. Mouat, In-
spector-General, Madras.)

1287- “ Aneurism of the abdominal aorta, just after its exit through the
diaphragm, through which it burst, by an opening as large as a rupee,
into the left pleural cavity. The large sac is laid open, showing that
the bodies of the three upper lumbar vertebrae have, to a consider-
able extent, been absorbed, leaving the intervertebral cartilages

188

DISEASES OF THE ARTERIES.

[SEUIES VI.

intact. The opening from the aorta into this sac has smooth
edges, and is about the size of a rupee” (Ewart).

The sac of the aneurism is very large, extends from the under surface
of the diaphragm to the iliac fossa. It is formed almost entirely
by the outer, fibrous, thickened tunic of the aorta. The lining
membrane of the latter is throughout highly atheromatous.

“The patient, a Hindu, had a variety of treatment, having no reference
to aneurism, the disease being unsuspected. Indeed, in order to
relieve pain in the loins, it was his practise to get his mother to
stand upon him and press him there with her feet. Having
been a short time in hospital, he died by bursting of the aneu-
rism through the diaphragm.” (Allan Webb, Pathologia Indica,
No. 10-10, p. lv.)

288. Double aneurism of the abdominal aorta. One is the size of
a hen’s egg, the other of an orange. They arise almost directly
opposite each other from the aorta, just beneath the diaphragm,
and the smaller tumour appears to involve also a branch (p the
gastric) of the cceliac axis. It is filled with firm, solid coagulum,
the portion of the artery involved (indicated by a glass rod)
being found in the same condition. The orifice of communica-
tion is oval, one inch in length, half an inch in breadth. The sac
is formed by all the coats of the vessel, and has a globular out-
line. The larger aneurism has pressed backwards against the
spine, causing extensive excavation and caries of three or four
vertebrae. These are well displayed in the preparation, the
aneurismal tumour having been dissected off and displaced to one
side. The sac is very thin where it rested upon the spine, and
has got torn. It was filled with laminated fibrin. The whole
of the aorta is wide and extensively atheromatous. No history.
( Presented by Dr. Bedford.)

289. Aneurism of the abdominal aorta. The sac is almost completely
filled with ver3r firm, dense, distinctly laminated fibrin. It
communicates with the aorta by a wide orifice, and its ^external
surface is thickened by adventitious adhesions to the surrounding
soft parts. No history.

290. “ Enormous aneurism of the abdominal aorta, just below the
diaphragm. The sac, which is almost filled with coagulum,
adheres above to the diaphragm, below to the lesser curvature of
the stomach, and involves the cceliac axis. The oesophagus, into
which a glass rod had been passed, is greatly compressed by the
tumour. The patient, a Musalmani woman, aged 39, was
admitted on the 4th April 1864, and died on the 8th May 1864.”
(Oolles.)

291. An aneurism of the abdominal aorta, the size of a hen’s egg,
taking its origin at the root of the superior mesenteric artery.
The sac is somewhat conical in shape, and involves all the coats
of the aorta, communicating with the latter by an orifice of
oval shape, two inches in length and an inch wide. The margins
of this orifice, and the walls or sac of the aneurism are very hard,
and almost completely calcareous. The sac is lined by a distinct
layer of laminated fibrin, covered by a recent, soft, and dark

series vi.] ANEURISMS OF ABDOMINAL AORTA.

189

coagulum. The superior mesenteric artery at the summit
apex of the aneurism is completely obliterated. The inferior
mesenteric, renal, and phrenic arteries are abnormally large and

tortuous. The aorta, throughout, is much thickened and

The

292.

atheromatous. Below the aneurism its channel is narrowed,
specimen was found on the post-mortem examination of a
European, aged 65, who died in hospital from acute pulmonary
tuberculosis. There were no symptoms referring to the
aneurism during life. (See further, .“Medical Post-mortem
Records,” Yol. II, 1876, pp. 7-8.)

Aneurism of the abdominal aorta, about the size of an orange
situated just below the diaphragm, and in close proximity to
(but not actually involving) the cceliac axis. It projects
anteriorly and to the right of the spine. The sac of the aneurism
was firmly united to the vena cava laterally, and in front, to the
pancreas, mesentery, &c. Its orifice of communication with the

n i r~ TT-r-1 ✓ 1 /-v n 1 \ ■ 1 4- ^ ) 1 ■» v» /iL i ... 4- . . .. ,1 1 i , ,

aorta is wide — about 2^ inches in diameter — and rounded, the

293.

margin thickened and partially calcified, and so also is the interior
of the sac throughout. It is lined by a little stratified fibrin but
was chiefly filled with fresh recent coagulum. The subject was
an adult Hindu (age not stated). (Presented bp Assistant
Surgeon Gopal Chunder Roy, Howrah.)

Aneurism of the abdominal aorta, proving fatal by rupture into
the left pleural cavity. From a European (Italian) seaman,
aged 42, who died in hospital.

Dn opening the abdomen, the intestines were found pushed towards the
right side by a large, dark mass, which occupied the whole of the
left hypochondriac, left lumbar, and inguinal regions. The posi-
tion ot the left kidney could not be identified. The peritoneal
cavity itself remained intact. On careful examination, this mass

was found to consist of ■extravasated blood - a huge coagulum in

the retro-peritoneal cellular tissue surrounding the left kidney, and
was derived from a ruptured abdominal aneurism, situated ’ just
below the diaphragm, almost opposite, but a little to the left of
the cceliac axis. When entire, its size must have equalled a large
orange. The sac was for the most part empty, but contained on
one side, a layer of laminated fibrin, about an ' inch in thickness
hollowed at its centre. The sac is much thinned superiorly and
to the left where rupture took place. Two ragged openings are
here met with, one nearly an inch in length, the other large
enough to admit a finger. Through these, haemorrhage had taken
place into the retro-peritoneal tissues, and, by implication of the
diaphragm, into the left pleura. The left kidney was found imbed-
ded in the abdominal coagulum. Posteriorly, the aneurism was
found to have pressed upon and deeply eroded the first lumbar
and the twelfth, eleventh, tenth, and a portion of the ninth dorsal
vertebrae, both the intervertebral cartilages and the bodies of the
vertebrae being hollowed out. In the left pleural cavity an
enormous blood-coagulum, weighing 2 pounds 13 ounces/ was

found, as also about fifty ounces of sanguineous serum, the former
taking ~ ' ‘ 1 1 ‘ ’ ’ " '

a distinct and complete mould of the cavity and beariim the

190

DISEASES OF THE ARTERIES.

[series VI.

impressions of the lower ribs. The body was pallid. The brain,
heart, lungs, and other viscera were all pale and almost bloodless.

294. Aneurism of the abdominal aorta, terminating fatally by rupture
into the right pleural cavity.

“ The body was blanched, heart empty and firmly contracted. There
was a large amount of coagulated blood in the right pleural
cavity, which had compressed the right lung, and pushed the liver
low down into the abdomen. Left lung pale and crepitant
throughout. Liver and spleen healthy, as also the kidneys.
There was a swelling on the aorta between the pillars of the
diaphragm, extending up into the thoracic cavity. On the right
side there was a rent passing into the swelling or aneurism and
communicating with the right pleura. The aneurism is sacculat-
ed, and on the posterior part of the artery it had so pressed on
the bodies of the eleventh and twelfth dorsal vertebrae that it had
destroyed their periosteum, and exposed the bone to a considerable
extent. The large opening posteriorly, in the preparation, is
where the aneurism was closely united to the vertebrae. The
smaller opening in front and to the right is where it burst. (The
arch of the aorta gives off four branches, the unusual one being
the left vertebral.)

History. — Daniel Wallace, an American seaman, of the ship Lucy S. Wells,
was admitted into the General Hospital on the 19th of May 1877.
He stated he had suffered from pain in the epigastrium lor about
the last three months. It increased when his stomach was full, and
on exertion. It came on rather suddenly at first, while he was at
work. There was a good deal of visible pulsation at the pit of
the stomach ; no distinct tumour. There was a bruit to be heard
about the middle of the epigastrium. The heart’s sounds were
normal. During his stay in hospital the pain and uneasy
symptoms in the epigastrium gradually got worse. After a time
he complained ol great dorsal and lumbar pain. A couple of
days before his death, it was evident that a tumour existed at
the pit of the stomach, it was distensible, and a distinct bruit
could now be heard over it. The pain was very intense, especially
in the back. He felt also as if his bowels were being, drawn up
towards his chest. He died suddenly, on the morning of the
11th September, becoming faint and blanched just before he
expired. ( Presented and described by Dr. E. C. Nicholson,
General Hospital, Calcutta.)

295. The thoracic and abdominal aorta highly atheromatous and
thickened, and exhibiting an aneurismal dilatation, the size of a
walnut, in connection with the former, and a sacculated, ruptured
aneurism, the size of an orange, in connection with the latter.—
From a Mahomcdan (Arabian) woman, aged 30, who died in

hospital. . , . . . . .

The rent or rupture is large, ragged, situated on the anterior aspect
and near the upper end of the sac. The latter was firmly
adherent to the first three lumbar vertebrae behind, ana in front
and above to the transverse colon, pancreas, and pyloric end ol
the stomach. Its orifice of communication with the aorta is

series vi.] ANEURISMS OF TIIE INNOMINATE.

191

divided by an incomplete, thickened, and atheromatous septum.
The sac projects from the anterior aspect of the aorta, and is
much thickeued by adventitious adhesions to the surrounding
parts. For about half an inch from its orilice, all the coats of
the vessel may be traced into the sac ; beyond this, it is only
formed by the outer or fibrous tunic greatly thickened. It is
situated just below the coeliac axis, and the superior mesenteric
artery arises from just within the lower margin of the mouth of
the aneurism. The latter is filled partly by laminated, partly by
soft, dark, blood-coagulum, a good deal of which was found
protruding from the rent in the sac. A very large amount of
fluid and coagulated blood was found extravasated in the
peritoneal cavity.

The other smaller aneurismal dilatation, situated in the thoracic portion
of the aorta, lay just below the root of the left lung, exactly
in the median line, and on the anterior surface of the vessel.
It was lined by a small, concave, laminated coagulum. (See
further, “ Medical Post-mortem Records,” Vol. Ill, 1880
pp. 425-2G.)

*295a A small dissecting aneurism of the abdominal aorta, about the
size of a cherry-stone. It encroaches very much upon the right
common iliac artery, at the point of its origin. A small
rounded opening in the lining membrane of the aorta leads into
this false aneurism, which is formed apparently by the separation
of the inner from the middle coats of the vessel. The lesion
appears to have been healed spontaneously by the deposit of
laminated fibrin. — Taken from a native woman, aged 58, who
died in hospital from chronic Morbus Brightii, with athero-
matous degeneration of the whole of the aorta — thoracic and
abdominal. (“ Medical Post-mortem Records,” Vol. II 1S77
pp. 457-58.)

296. Preparation showing an aneurism of the innominate artery, the
size of a walnut, which ruptured into the trachea. The interior
of the sac is seen to be lined by a few layers of laminated fibrin.
The mouth, corresponding to the orifice of origin of the
innominate from the arch of the aorta, is rounded, smooth, and
about the size of a shilling. A ragged opening, sufficiently
large to admit a goose-quill, is seen at the point of rupture into
the trachea; it is partly closed by a valve-like fold of the
mucous membrane of the latter. The whole of the arch of
the aoita is in a state of fusiform dilatation, and its lining
membrane rough, irregular, and greatly thickened from at her o"-
matous changes. The patient, Daniel McL., a Scottish seaman,
was admitted into hospital on the 5th of May 18G7, and died
from sudden and profuse haemoptysis on the 28th July. (Pre-
sented by Professor S. B. Partridge.)

B97. “ Small aneurism of the arteria innominata. The sac is about

the size of a pigeon’s egg, and is firmly adherent to the anterior
wall ol the trachea, which it has perforated three inches
below the rima glottidis. Anteriorly, the parieties of the sac are

192

DISEASES OF THE ARTEKIES.

[series VI.

pretty thick from the more or less perfect preservation of the
middle and external tunics. Posteriorly, these have given way, at
an early period, and then the trachea formed the inner wail of the
aneurism ; this at length gave way, and the patient succumbed
from haemoptysis and asphyxia. The orifice in the trachea runs in
its greatest diameter transversely to the axis of the tube,
and its edges are irregular and jagged. The mucous membrane
around this is thickened, puckered, and raised from inflammatory
action and exudation. The rent is about half an inch long,
and is indicated by the insertion of a glass rod, which also passes
through the long axis of the aneurismal sac. T he ascending
aorta, which is unopened, is seen to be aneurismally dilated ”
(Ewart). ( Presented by Dr. Herbert Baillie.)

298. “ Parts exhibiting aneurism of the innominata, with a portion
of the arch of the aorta. The tumour is as large as a Sevdle
orange, and presses upon the anterior surface of the trachea,” The
latter was opened and examined from behind, “ but no ulceration
or local degenerative change found, nor in the bronchi, although
at one time there was evidence of pressure upon the right
bronchus. The innominate vein and right pneumogastric
and recurrent nerves were subjected to pressure. The sac is laid
open in front, and is filled with fresh coagulum of a dark-red
colour, in which there is scooped out a channel for the circulation
of the blood from the aorta into the subclavian and carotid.
The patient died from pneumonia and dysentery ” (Ewart).
The right lung, consolidated from pneumonia, is preserved with
the specimen.

299. “Aneurism of the left common carotid artery, at its
bifurcation, extending along the internal carotid. The subject
of this aneurism was admitted into hospital on the 4th of
February 1846, with a pulsating tumour, the size of a walnut,
situated at the left side of the neck, between the sterno-
cleido-mastoideus and angle of the jaw, and opposite to t.he os
hyoides. The pulsation and aneurismal thrill were distinct. Bv
the stethoscope a rushing sound was heard. By pressure on the
common carotid, at the anterior inferior triangle, the tumour
lost its pulsation, became soft, flaccid, and diminished in size,
but as soon as the pressure was removed, it became hard, pul-
sating, and resumed its former dimensions. Patient stated that
seven days ago he experienced pain in his neck, and on laying
his head on a pillow, on the left side, lie felt as if the head was
raised at each contraction of the heart. This made him examine
his neck, when he noticed for the first time a pulsating tumour,
little smaller than at the time of examination. The pain
gradually increased, extending towards the left occiput. When
lie came under observation, he complained of much pain in the
tumour and about the occiput on the slightest movement of
his neck. He is unable to swallow any solid food, owing to the
pressure of the food on the pharynx. Until two years ago, he
was a lascar on hoard the ship Thames. He was temperate,
and met with no injury about the neck. T he common carotid

193

series vi.] ANEURISMS OF COMMON CAROTID.

‘

was ligatured on the 9th of February. He died on the Sth of
March, and the post-mortem runs as follows : —

‘The tumour in the neck greatly diminished in size, flat, and flaccid. On opening
the left eye, the cornea was observed to have sloughed away, the humours
had escaped, and the organ was collapsed. The whole of the left side of
the neck was in a state of complete disorganization from sloughing.
Bubbles of air escaped as it was cut into, and also a quantity of thin,
watery fluid, almost black, mixed with blood, resembling tar. The ligature
had separated from the artery, and was found lying in the wound un-
attached. The artery lay in the internal division of its sheath, divided
by the ligature, with the two orifices almost in contact. The lower
orifice was plugged up with a coagulum of blood to within half an inch ot
the origin of the vessel from the aorta, where it commenced so close to the
innominata that it might be said to arise together with it from a common
origin. The upper orifice of the divided carotid was also filled with
coagulum, which extended up to the aneurismal sac. The aneurism was
situated at the bifurcation of the common carotid, and extended along the
internal carotid about an inch. The sac was full of coagulated blood.
Internally, towards the pharynx, there was a large opening into that canal,
from sloughing of its parities. The common carotid artery was found
perfectly healthy. External to the divided artery, the par vagum was
sound. External to this nerve, the jugular vein was perforated by ulcer-
ation, the opening being ragged. The upper portion appeared to have been
destroyed for about an inch and a half. Its posterior wall was adhering
to the surface of the aneurismal sac. On cutting into this part of the
vessel, its internal coat presented a bright red inflammatory appearance.
The sloughing of the neck extended from the angle of the jaw backwards
to the spinous processes of the vertebrae as high as the occiput, and down
the side of the cervical region to within an inch and a half of the clavicle.
On raising the pharynx, and making an opening into the posterior and
upper parts of that bag, two large ulcerated holes were found on its left
side communicating with the sac, one opposite the isthmus of the fauces,
and the other below it, on a line with the glottis, both large enough to
admit the tip of the thumb. It must have been through these openings
that the blood escaped for some time and tinged the expectoration. The
lining membrane of the trachea and bronchial tube appeared to be in a high
state of inflammation. The heart and vessels arising from it presented a
normal appearance. The brain was sound, but the vessels on its surface
were congested and filled with tar-like blood, similar to that found
surrounding the aneurismal sac. On opening the left cavernous sinus, it
was found to contain coagulated blood. The ophthalmic artery seemed dis-
tended. Its lining membrane was of a bright, florid rod appearance. The
arteries on the right side of the neck were injected with coloured wax, but
although the injection ran freely into even the small branches of the
external carotid, none of the vessels were filled with it either in the
neck or face’” (Ewart’s Catalogue, No. 697). ( Presented by Professor

R. O’Shaughnessy.)

300. “ Aneurism of the carotid artery. The preparation exhibits a

very large aneurismal tumour arising near the bifurcation of the
right common carotid artery, and involving also the internal
carotid. The skin over the sac is considerably thinned, at some
places (lower and back part) actually inseparably adherent to
the tumour. The sac itself extends from the clavicle quite to
the base of skull above, and from the median line in front to the
cervical vertebra) behind. The sterno-mastoid and platysma
muscles were found considerably stretched and flattened out.

In dissecting out the part where the carotid artery was deligated (see history
below), no clot was found in the vessel below the seat of the ligature, while

194

DISEASES OF THE ARTERIES.

[series VI.

the part above was partially plugged bv a small, in formed coagulam. On
making a slight incision into the sac, a large quantity of grumous. fluid
blood, mixed with soft pieces of coagula, escaped from the aperture. On
introducing the finger through this, the mastoid process and the transverse
processes of the cervical vertebrae could be distinctly felt. The cornu of
the hyoid bone was felt projecting into the sac, covered by a very thin,
smooth membrane. There were no consolidated layers of cnagulum in the
sac. The vagus is somewhat thickened, but otherwise apparently healthy
at the spot where the artery was tied. The recurrent branch was cedema-
tous and imbedded in the exudations thrown out. An opening is seen at
the lower part, which appears to be the aperture of communication of the
internal carotid with the sac. On laying open this artery, the cerebral end
was found thin, and apparently filled with granular matter.

The common carotid of the left side divided itself behind the angle of the lower
jaw. The heart was of natural size, and its valves normal. The aorta free
from atheromatous doposit. The lungs were partially congested, scattered,
patches of semi-solid character in the rieht. A hydatid in the liver. A
large number of round worms in the small intestine.

The sac is now stuffed with cotton.

History. — Case of Ram Chand Auddy, aged 32, a Hindu, admitted
into the hospital on the 17th of April 1870, with a pulsating
tumour in the right side of his neck. This first commenced
about a year and a half ago as a small, pulsatile swelling, at
about the middle of the neck. It has been increasing gradually
in bulk, and accompanied, for the last month and a half, with
persistent, severe, lancinating pain in the part. There has been
partial loss of sensation in certain portions of the right ear for
the last three months. About a month prior to the first appear-
ance of the swelling, the man received a pretty smart slap on
his right ear and upper part of the neck adjoining. Had never
suffered from any difficulty in breathing or in swallowing. Has
been always of sober habits. No history of any hereditary
affections. The pulsations in the tumour were synchronous with
the cardiac systole and radial pulse.

The common carotid was tied below the omo-hyoid muscle. No return
of pulsation or bruit in the tumour occurred after the operation,
and there were no symptoms of cerebral or circulatory dis-
turbance, except some partial pneumonia. The ligature came
away on the 14th day, but secondary haemorrhage took place
that same night. The innominate artery was tied at midnight
at the spot indicated by the green glass rods. The bleeding was
cheeked, but the patient gradually sank, and died about twenty-
four hours after the last operation.” ( Presented by Professor
S. B Partridge.)

301. Preparation showing a large aneurism of the root of the right
common carotid artery. The heart and aorta, trachea and
oesophagus have been preserved in situ. The aneurism is about
the size of the closed fist, very closely adherent to the skin of
the neck, which during life was tense and stretched, of a pur-
plish colour, and much thinned from pressure. The aneurism
is seen to have developed just above the bifurcation of the
innominate, which vessel is larger ('more dilated) than normal,
but forms no part of the aneurismal sac. The latter ascends

series vi.] ANEURISMS OF COMMON CAROTID.

195

upwards and outwards into the neck, the lower half of the right
carotid participating in its formation, while the rest of this vessel,
traced upwards to its bifurcation, is greatly reduced in size, and
really external to the sac. The right subclavian artery is also
reduced in size, its orifice of origin from the innominate elliptical,
and flattened from compression, the lower part of the aneurism
pressing upon this vessel in its “first portion.” The original sac
(for the aneurism is a diffuse one) is about the size of a duck’s
egg. Its rounded, somewhat abrupt margin can be readily dis-
tinguished. The main portion of the sac, however, is formed
by the cellular tissue and adjacent muscular fibres of the stern o-
mastoid and platysma muscles, of the deep and superficial fascite
of the neck, &c., all flattened out and condensed around the pri-
mary aneurismal expansion. The interior of the latter is lined by a
thin layer of recent soft coagulum, while at the lower part, just
above the root of the right subclavian, where the sac forms a
kind of little diverticulum, a mass of stratified, fibrinous deposit
is found, about the size of a walnut, almost entirely filling it.
The inner surface of the true sac is rough and tuberculated from
atheromatous changes. The ascending portion of the aortic
arch is dilated, and its interior can be felt to be thickened and
atheromatous. The aortic valves show slight opacity and cohe-
sion. The mitral flaps seem to be healthy.

While the sac of the aneurism is intimately adherent to the
integument of the neck on its anterior and outer aspects, it is
also closely adherent to the trachea and oesophagus on the
inner side, and to the spine posteriorly. Indeed, in the last direc-
tion, the pressure has been so considerable that the bodies of the
seventh cervical and first dorsal vertebra? are found superficially
excavated and rough.

The left common carotid and left subclavian arteries are abnormally
largo. Both trachea and oesophagus were found greatly displaced
to the left of t tie spine, and the mucous membrane of both,
especially opposite the sac, was red and congested. — From a native
male patient, who died in hospital.

302. Aneurism of the right subclavian artery, in its first portion. The
piimarv dilatation seems to have been only the size of a pigeon’s
ai,d to have occurred at the root of the thyroid axis, and
extended above and to the outer side of this vessel. A secondary
dilatation of the sac appears to have taken place, in which the
external tunic only forms the wall of the aneurism, and this has
resulted in a tumour the size of an orange. Both primary and
secondary sacs are partially filled with laminated fibrin. The verte-
bral artery and thyroid axis are pervious and dilated. The superior
intercostal, which arises from the back part of the sac, is contracted
and atrophied. At the extreme outer and upper part of the sac,
where it presented in the neck, the skin is seen to be adherent to
it, and a laceration or perforation is here observed, through which
it burst and produced death by hoemorrhage. The right common
carotid artery is a good deal thickened, as it lies on the inner
aspect of the tumour. ( Presented bjj Professor O’Shaughuessy.)

196

DISEASES OF THE ARTERIES.

[series VI.

303. Aneurism of the right subclavian artery. It arises from the
“ second portion ” of this vessel, just beyond the thyroid axis.
The primary sac is about the size of a walnut. This appears to
have expanded outwards and upwards, increasing the size of the
tumour to that of an orange, i.e. has developed a secondary sac
by a progressive thinning and attenuation of its walls. To the
extreme outer margin of the sac a portion of the integument of
the neck is seen firmly adherent, and exhibits an irregular-
outlined, ragged rupture or laceration, the size of a two-anna
piece. Two or three smaller perforations of the sac are seen
near the large one above described. The trunks of the right
internal mammary and vertebral arteries are seen at the inner
side of the aneurism, and the origins of the thyroid axis and
superior intercostal close to, and partially blended with the sac.

The main vessel (right subclavian) has been opened from behind. 1 lie
arch of the aorta is slightly dilated ; it gives off an additional
branch from its transverse portion, an artery as large as the
radial, and probably the left vertebral. No history of the case
exists.

304. “ Aneurism of the external iliac artery, from a native.” (Webb’s
Pathologia Indica, No. 9G8, p. lv.)

The aneurism is of oval shape, the size of a walnut. It appears to have
involved the lower half of the artery, reaching as low down as
Poupart’s ligament. A ligature is seen placed on the external
iliac (right) on the proximal or cardiac side of, and quite close '
to the sac, and from this spot upwards to the bifurcation of the
common iliac the artery is filled with firm coagulum. The sac
(now opened) is occupied by soft, grumous blood-clot, in which
the outline of the diseased portion of the vessel can be readily
traced. The femoral emerges from the lower margin of the
aneurism, greatly reduced in size, but still quite pervious, and
the epigastric and circumflex iliac branches of the femoral are
also patent. Inseparably united to the sac, and lying to the
inner side and a little behind it, is the external iliac vein.
The sac proper is composed of the external tunic of the artery
only, but is much thickened by adhesions to the surrounding
soft parts, and thereby the outline of the aneurism is increased
to about twice its true size. ( Presented by Professor R.
O’Shaughnessy.)

305. A dried preparation of an aneurism of the external iliac artery,

the size of a small orange. Three or four small sacculated
pouches are developed from the primary or principal sac. The
walls of the latter are thin and delicate, and on the anterior
aspect exhibit a vertical laceration, an inch in length, which
proved fatal. The artery above and below . the tumour appears
to be dilated. The deep epigastric and circumflex iliac arteries
are seen to arise directly from the lower part of the sac. I

306- Aneurism of the left popliteal artery. The left common iliac, left
internal, and external iliacs, the left femoral, and popliteal arteries,
with their principal branches, have been preserved. I he cineu
rismal tumour, now partially destroyed, was the size of a tui key s

SERIES VI.]

POPLITEAL ANEURISMS.

197

egg, and very strongly adherent posteriorly to the ligament
of Winslow. The sac was thin and imperfect, in part composed
only of the condensed cellular and other soft tissues ot the
popliteal space. The mass of decolourized clot found in the sac
represents in the preparation the exact situation of the tumour.
The arteries have been imperfectly injected, and the parts so
quickly decomposed that a good dissection was not possible ;
but the circulation in the aneurism seems to have been consider-
ably lessened, if not completely obstructed, by the compression
over the upper part of the femoral (see below) which was
employed during life. The gluteal and sciatic branches of the
internal iliac, the perforating branches of the profunda, and
the articular branches of the anterior and posterior tibial arteries,
are all very much enlarged.

The patient, J. W. M., a European seaman, aged 30, stated on
admission into hospital that the aneurism “ had appeared or
developed spontaneously, he having received no injury, nor
ever having suffered from syphilis, &c.” The treatment adopted
was perfect rest in bed, low diet, and compression over the
femoral in Scarpa’s triangle, at first digital and then instru-
mental. Complete consolidation of the tumour was effected,
and the patient seemed to be progressing most favourably when
he was attacked with typhoid fever, from which he died. (iVe-
sented b>/ Professor H. C. Cutcliffe.)

307- Preparation showing a diffused aneurism of the leftpopliteal artery,
about the size of an ordinary orange. Prom a native male
patient, aged 25. The femoral, in Hunter’s canal, was ligatured
in the first instance, with the result that all pulsation in the
aneurism ceased, and it apparently began to consolidate. But
the skin covering the popliteal space became gangrenous. A
small bulla first made its appearance, then gave way, leaving
an unhealthy ulcer ; this deepened, and at last exposed the sac,
from which oozing, and afterwards formidable haemorrhage, took
place. The sac was now cut down upon, several large, laminated
clots were removed, and an attempt made to ligature the ends of
the vessels above and below the site of the aneurism. The
ligatures, applied after great difficulty, did not control the
haemorrhage, and, as proved subsequently, were placed on the
vein, not on the artery. The limb was therefore amputated at
the lower third of the thigh, and the patient did well (recovered)
after the operation. In the preparation, two white glass rods
have been passed into the upper and lower ends, respectively, of
the artery. The original aneurism, as traced from the diseased
and torn condition of the arterial wall, seems to have been about
the size of a walnut, but had subsequently become diffuse, and a
false sac has been formed from the loose cellular tissue, Ac., of
the popliteal space

The aneurism had existed for about two and a half months at the date
of the patient’s admission into hospital. During this period he
has suffered a good deal from throbbing and lancinating pain in
the ham, but was still accustomed to walk to his work daily,

198

DISEASES OF THE ARTERIES.

[series VI.

i.e. four or five miles. There was no history of injury or
strain. The man had, however, contracted -syphilis about five
years previously, which was followed by secondary eruptions and
articular pains. ( Presented hy Professor K. McLeod.)

308. A preparation exhibiting the direct origin of the right and
left carotid arteries from the arch of the aorta. The left sub-
clavian arises in the ordinary situation, and is seen giving off'
the left vertebral, but the right subclavian artery springs from
left extremity of the arch, and passes behind the trachea to its
destination.

309. “ Preparation showing unusual distribution of the renal arteries.
The lumbar portion of the vertebral column with the kidneys and
a portion of the abdominal aorta are in situ. From the
right side of the aorta a common renal artery is seen to arise,
which, about an inch outwards, divides into two trunks, of
which the superior subdivides into four branches, and the
inferior into two. These branches then enter the hilum. The
ureter is seen between the two main trunks. Just below the
inferior mesenteric artery, another artery arises, which, after
describing a gentle curve, is directed upwards and eventually
lost in the substance of the inferior extremity of the kidney.

From the left aspect of the aorta arise three distinct renal arteries,
each of which subdivides into several smaller branches, which
enter the hilum of the organ. The left spermatic artery springs
from the most inferior trunk. The ureter lies between the
superior and inferior trunks, whilst the middle one is situated
behind it. This specimen was obtained from the body of a native
male, in whom there appeared to have existed a highly developed
condition of the vascular system ; for, even with the common,
coarse injection used in the dissecting-room, almost all the vessels
in the various organs were filled to an unusual size ” (Ewart).
( Presented hy Moulvie Tatneez Khan, Khan Bahadur, late
Demonstrator of Anatomy.)

310. “ Specimen showing the ‘middle thyroid of Neubauer/ arising
from the arteria innominata, and running up in front of the
trachea to the thyroid gland. Such an artery would seriously
complicate the operation for tracheotomy ” (Colles). ( Presented
hy Moulvie Tameez Khan, Khan Bahadur.)

311. “ The heart of a young native woman, who died of dropsy
depending on disease of the abdominal viscera. The heart is
healthy and well-formed, but the origin of the aorta lies to the
left of and behind the infundibulum, and the arch crosses the
bifurcation of the pulmonary artery from left to right. The
innominate divides into the left carotid and left subclavian, and
the right carotid and subclavian arise by separate origins ”
(Colles).

312. “ Irregular origin of the left vertebral artery from behind and
between the origins of the left carotid and subclavian. The
right vertebral arises naturally” (Colles). {Presented hy Baku
Chunder Mohun Chose, m.b., late Demonstrator of Anatomy.)

VI.] ABNORMAL ORIGIN AND DISTRIBUTION.

109

“ Irregular origin of the vessels from the arch of the aorta. The
arteria innominata divides into the two carotids. The left sub-
clavian rises next, and behind and to the left of it rises the right
subclavian, which ran behind the oesophagus to its own side of
the neck ” (Colies).

“ Irregular origin of the left carotid from a short trunk, which
also gives off the arteria innominata. The left subclavian rises
regularly” (Colles).

The heart, arch of the aorta, and the lower part of the cervical
spine, showing the abnormal origin of the left vertebral artery
from the arch, between the left common carotid and subclavian
arteries.

The arch of the aorta with only two branches arising directly
from its transverse portion. These are the innominate and
left subclavian arteries. The former gives off, about a quarter
of an inch from its origin, the left common carotid arterv, which
then passed upwards to its usual position on the left side of the
neck. Having ascended for an inch, the innominate divides
regularly into the right common carotid and right subclavian.
(Presented by Babu Chunder Mohun Ghose, h.b., late Demon-
strator of Anatomy .)

An exactly similar specimen to No. 31G. Found on the post-
mortem examination of a native male, aged 50, who died from
morbus cordis (mitral stenosis).

Another similar specimen. The left common carotid is seen to
arise from the innominate, about three lines above the origin of
the latter from the arch of the aorta, and an inch beyond this
the innominate divides normally into the right carotid and
subclavian arteries. I ound on post-mortem examination of a
native woman, aged 50, who died in hospital from acute hepatitis.
Arch of the aorta, showing four branches instead of three. There
is no innominate artery. The right subclavian and right carotid
arteries, like the corresponding braehio-cephalie vessels of the left
side, arise directly and by separate and independent origins
from the aorta.— From an Armenian (male), aged 40, -who died in
hospital from opium-poisoning.

The right brachial artery, from a subject in the dissecting-room,
showing a division of the vessel about half an inch below the
origin °f the superior profunda. The smaller of these gives off
the inferior profunda and anastomotica, and then unites with the
larger branch to re-form a single brachial artery, which imme-
diately bifurcates into ulnar and radial arteries. The median
nerve passed out between the two trunks” (Colles). (Pre-
sented by Babu Chunder Mohun Ghose, m.b., late Demonstrator
of Anatomy.)

“Irregular distribution of the right radial artery. From a
European seaman. About two and half inches above the lower

vnL°KthenadiuS’uth-e/adial artei7 §Pves off the superficial
volar branch, which is larger than usual ; the radial then turns

outwards and downwards till it reaches the outer border of the

radius, rather to its posterior aspect, and proceeds downwards

DISEASES OF THE ARTERIES.

[series VI.

and slightly inwards to the interval between the first and second
metacarpal bones. It crosses the extensor tendons of the thumb
on their superficial aspect, and runs behind them for nearly two
inches. The superficial volar gives off the anterior carpal branch
as well as the external dorsal artery of the thumb. There is no
superficial arch, the ulnar supplying all the branches as is often
the case. The deep palmar arch and the other arteries of the
hand and forearm are normal” (Colies).

322. I rregulaf formation of the circle of Willis at the base of the brain.
The left middle cerebral artery gives off a large branch, which
passes forwards and divides into the two anterior cerebral
arteries. There is no anterior communicating artery, and only
indirect anastomotic communication between the right middle
and anterior cerebral vessels. On the left side again, the pos-
terior communicating artery is normal, as also the left posterior
cerebral, which, however, is more like a continuation of the
basilar. On the right side there is no posterior communi-
cating artery, but the middle cerebral gives off the right pos-
terior cerebral, and the latter communicates with the basilar by
a very delicate and minute artery. The basilar itself is formed
by the coalescence of the vertebrals, but as it lay upon the pons
was observed to have a peculiar curved or b-shaped outline.
From a native woman, Nasiban, aged 38, who died in hospital
from chronic Bright’s disease, &c. ($eealso preparation No. 2 f)5a
from the same patient.)

323. Abnormally-formed circle of Willis, with slight atheroma of its
larger vessels, particularly of the middle cerebral arteries. These
arteries give off; the posterior cerebral arteries instead of the
posterior communicating, while minute branches passing for-
wards and outwards from near the point of the basilar on either
side complete the anastomotic circle. — From an aged East
Indian (male), who died from dysentery.

324. Atheromatous circle of AVillis, with a somewhat peculiar
formation of the same. The left posterior communicating artery
is unusually large, and takes the place in distribution of the
posterior cerebral of this side, while the basilar artery only gives
off two small branches to the left and a large righ j postei ior
cerebral. — From an aged European ( cetat 75), who died in
hospital from chronic dysentery.

325 “ Wound of the femoral vein. At the lower part of the pre-
paration there are two incised wounds, opposite each other, as if
the vessel had been penetrated by a sharp instrument. The
artery is uninjured ” (Ewart). ( Presented by Professor Eat well.)

326 Left femoral artery and vein. About an inch and a half below
the profunda femoris, a ligature is seen enclosing the main
artery, and has also accidentally included the adjacent portion
of the femoral vein. The latter shows evidences of phlebitis.
It is said to have been found “full of pus.” Its walls are
thickened and closely adherent to the artery.— From a case ft
amputation of the thigh. The patient died from pyaemia, the
result of the implication of the vein.

SERIES VI.]

DISEASES OF THE VEINS.

201

327.

328.

329.

330.

331.

332.

A preparation showing inflammation of the axillary vein after
ligature of the same, and of the artery, in an amputation at the
shoulder- joint for gunshot injury to the arm. The thickened con-
dition of the walls of the vessel are well seen, as also the presence
of a softening thrombus within its channel, reaching backwards
from the site of the ligature for an inch and a half to the first
large collateral branch above, which is indicated by a red glass
rod. The axillary artery appears to be healthy, — its internal
and middle coats have been divided by the ligature.

The popliteal artery and vein, from a case of traumatic aneurism
of the former, for which both vessels were ligatured after
amputation of the leg. The arterial walls are seen here and
there irregularly thickened from atheromatous changes. The
vein was found in a state of acute inflammation, its walls
thickened, and lining membrane clouded, its channel occupied
by a softening thrombus (the remains of which can still be
seen) and puriform fluid.

A preparation showing the result of the application of an elastic
bandage for the purpose of keeping up extension of the joint,
after the adhesions had been broken down under chloroform,
in a case of fibrous ankylosis of the knee. Gangrene of the
foot and leg ensued, from which the patient, a native male, aged
30, died. The walls of the popliteal vein are thickened. Its
lining, membrane in the fresh state, presented a dark purple
ecchymosed condition. It contains a softening fibrinous throm-
bus, about two and a half inches in length. The popliteal
artery, compressed at the same spot, also shows some thickening
of its walls, but contained no thrombus. ( See further, “ Surgical
Post-mortem Records,” Vol. I, 1S78, pp. 535-36.)

“ Plugging of the saphena vein in two places by coagulum. In
the inferior part of the specimen the thickened vessel is laid open,
exposing a coagulum more or less broken down. At the upper
portion the pyramidal end of the second clot is observed.
The internal tunic is very opaque, greatly increased in thickness ”
(Ewart).

“ The external iliac vein containing a coagulum. Atthe upper part
of the specimen this is hollowedout.” It has formed immediately
above a valve placed in this situation. “ Below this point
the coagulum is smaller and does not nearly fill the vein. The
thickening of the upper two inches is well marked, contrasting
remarkably with the remainder.— From a man who died with
pyaemia ” (Ewart).

“ A portion of the femoral vein from the same subject, with a
coagulum in situ. Purulent matter was found between this
and the parieties of the vessel, which were much thickened.
This and the preceding specimen were taken from a man who
had sustained an injury to the left tibia. The veins leading
from the inflamed bone, and also the popliteal vein, were
arterial in the thickness of their coats, and completely occupied
by creamy, laudable-looking pus ” (Ewart). ( Presented hi
Professor J. Fayrer.)

202

DISEASES OF THE VEINS.

[series VI.

333. Left femoral and profunda veins with their corresponding
arteries. The former are seen occupied by “ red coagula ”
(thrombi), pretty closely adherent to the walls of the vessels,
which are dilated and rigid.

The patient, a European (Greek), died in hospital from abscess of the
liver. For some days before death there was much oedema
and swelling of the left leg, evidently due to the thrombosis
of these veins.

334. Thrombosis of the left femoral, profunda, and external iliac
veins. These vessels are seen occupied, and even distended by,
moderately firm, dark-red coagula.

The patient, a native male, aged GO, died from granular disease of the
kidneys with general anasarca. It was noticed during life that
the left leg and thigh were especially firm, cedematous, and
swollen, and that these conditions persisted in spite of repeated
acupuncture.

335* Suppurative thrombosis of the femoral vein. A specimen taken
from a case of pyaemia following amputation of the left thigh.
The walls of the vein are thickened, soft, and vascular, occupied
by a softening and puriform thrombus, which extended from
the stump through tliQ whole length of the vein, and reached
even up to the bifurcation of the left common iliac vein, where
it was replaced by dark , post-mortem clotting. The left femoral
artery, preserved with the vein, is healthy. From a native male,
aged 30. (“Surgical Post-mortem Kecords,” Vol. I, 18S0, pp.
G63-64.)

336. A decolourised, hollow thrombus, removed from a large uterine
vein in the right broad ligament. From a native women, aged
30, who died about eighteen days after abortion with subsequent
flooding. All the organs of the body were pale, anaemic, and
exsanguine. The heart showed patches of yellowish discolour-
ation in the left ventricle, and the muscular tissue here was found
in a state of advanced fatty metamorphosis.

337. Extensive thrombosis with contraction and solidification of the
inferior vena cava, from its origin at the junction of the common
iliac veins to its termination in the right auricle. Opposite the
renal vein the cava is enlarged so as to form an oval, tumour-like
swelling, rather larger than a pigeon’s egg. This, on section,
reveals a firm decolourised clot (? an embolus), firmly impacted
within the walls of the vein, with which it has acquired intimate
connections. It has a pale-yellowish colour, and smooth marbled
appearance. E xamined microscopically, consists of altered blood-
corpuscles only : — these are found shrivelled, contorted, and frag-
mentary, with also much blood-pigment (haematin), but no
morbid or extraneous cell-elements. The coats of the vein at
the seat of obstruction are three or four lines in thickness, much
condensed and resistant. The renal vein (opened from behind,)
is seen pervious up to the point of union with the cava, where
it is abruptly closed. The vena cava below the clot is quite
impervious, its walls thickened and fibrous-looking as far down
as the common iliac veins. These are also in great part occluded

SERIES VI.]

THROMBOSIS.

203

338.

339.

340.

341.

342.

by delicate, yet firm, fibrinous bands stretching across tbeir
channels. Above the clot, the cava exhibits the same condi-
tions; is contracted, and has the appearance of a firm, fibrous
cord up to the auricle. In the auricle a large, rounded, decolour-
ised coasfulum extends from the appendix downwards and inwards
through the auriculo-ventricular opening into the right ventri-
cle ; here it becomes thinner, more flattened, and passes upwards
into the pulmonary artery. No history of the case has been
preserved with this preparation. ( Presented by Professor

Edward Goodeve.)

The common and profunda femoral veins showing thrombosis of
the latter, with prolongation of the thrombus into the canal of
the common femoral, and its rounded expansion there. The
coagulum is firm, fibrinous, and partially decolourised. — Prom a
native male, aged 35, who died from cirrhosis of the liver with
ascites, and marked anasarca of the left leg and thigh, while, on

the right side, there was but slight oedema of the foot and leo-,

the thigh normal. (“ Medical Post-mortem Records,” Vol ° TI
1876, pp. 13-14.) ’ ‘ ’

The right common iliac, external iliac, and femoral veins, showing
the presence of an ante-mortem , fibrinous clot or thrombus,
which is partially organized, and has completely occluded these
vessels. There was marked solid oedema during life of the right
thigh, leg, and foot, while the left lower extremity remained
normal.— From a native female, aged 45, who died from
cerebral softening and scirrhus of the liver. (“ Medical Post-
mortem Records,” Vol. II, 1877, pp. 357-58.)

Thrombosis of the common and deep femoral veins, from a case
of moist grangrene of the foot, — a native male, aged 32, who
died in hospital. The thrombus or coagulum is decolourised
and shows central puriform softening. " It is closely adherent
to the walls of these vessels, which are unusually firm and
thickened, and the lining membrane has lost its natural trans-
parency and smoothness. (See further, “Surgical Post-mortem
Records,” Vol. I, 1879, pp. 333-34.)

Several large, ante-mortem , partially decolourised, and incipientlv
softening thrombi found obstructing the recto-vaginal and
vesico-vagxnal plexuses of veins, in a native woman” aged GO
Z, *?. . *rom dysentery and acute suppurative nephritis.’
( Medical Post-mortem Records,” Vol. II, 1876, pp. 33-34.)

A specimen exhibiting acute inflammation of the right spermatic
veins, which, at one part, have formed a kind of cluster or bunch
about the size of half a walnut. This was situated just above
the bnm of the pelvis, and, on incision, the dilated veins were
ound tilled with thick, yellow pus. There was hydrocele of the
right tunica vaginalis, which, about a month previously, had been
tapped and # injected. The sac had a healthy organising

appearance, and the testicle was normal, yet the phlebitis seemed
attributable to no other cause.— From a European, aged 40 who
died from serous apoplexy. ( See further, “ Medical Post-mortem
Records,” Vol. Ill, 1880, pp. 693-94.)

204

DISEASES OE THE VEINS.

[series VI.

343- Acute suppurative phlebitis associated with pyaemia. The
preparation shows the urinary bladder, which itself is healthy,
but the loose cellular tissue around the neck, for the space of
about two and a half inches, is much swollen, and of brawny
hardness. The vesico-prostatic plexus of veins is seen much
dilated, and occupied by dark-red, cylindriform thrombi, or
thick, purulent, broken-down blood-clot. The inner surface or
lining membrane of these vessels is very vascular and soft. There
were multiple pysemic infractions and points of suppuration in
both kidneys, and several small, circumscribed abscesses in the
lungs. — From a native male, aged 30, admitted with compound
comminuted fracture of the metatarsal bones of the foot, followed
by sloughing, and eventually by symptoms of blood-poisoning.

Surgical Post-mortem Records,” Vol. I, 1880, pp. 673-74.)

344- Venous aneurismal tumour removed from the axillary region of
a Hindu, Saroda, aged 45.

This sac or cyst is about the size of the foetal head. A small portion
of it was cut away during the operation (the rent has now been
stitched), and, at one part, is a rounded opening, capable of
admitting the little finger, which is the orifice of communication
of the sac with the axillary vein. The latter was ligatured
* above and below this spot, on the separation of the tumour.
The cyst contained only fluid blood, no coagula. On examining
its interior, there is found a layer of reddish, grumous, soft
material, two to three lines in thickness, unequally distributed
over the cyst wall. This material is easily scraped away, and
consists of fibrin, showing no lamination or decolourisation, and
presenting under the microscope only altered blood-corpuscles,
broken up and shrivelled, with much dark, amorphous pigment-
matter, and a few haunatoidin crystals. When this material is
scraped away, the inner surface of the sac or cyst is seen to be
smooth and shining, i.e. has a distinct lining membrane,— the
flattened, tesselated, and nucleated epithelial cells composing
which can quite readily be recognized under the microscope.
The rest of the cyst-wall consists of well-formed, fibro-elastic
tissue, with also smooth muscular tissue ; in fact, seems quite
identical with the ordinary structure of the walls of a vein ;
so that there can be no doubt that the sac was an aneurismal-
like expansion from or of the axillary vein, and is not an adven-
titiously-formed cyst. There are no dissepiments, or any indica-
tions of such, in the interior of the sac.

The duration of the growth was about two months. The patient at
first noticed a swelling about the size of a common betel-nut
in the left axilla. It was soft, painless, and caused but little
inconvenience ; has slowly increased to its present size. There
was no distinct history of injury or strain. Had syphilis
when sixteen years of age, and was treated by mercury. Had
since then considered himself a very healthy man. {Presented by
Professor K. McLeod.)

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

p a it rr iv.

I INJURIES AND DISEASES OF THE LARYNX,
TRACHEA, BRONCHI, AND BRONCHIAL
GLANDS; OF THE LUNGS AND PLEURA.

INJURIES AND DISEASES OF THE BRAIN
AND SPINAL CORD, WITH THEIR MEM-
BRANES AND BLOOD-VESSELS; ALSO OF
THE NERVES.

SeKIES VII AND VIII.

SERIES VII.]

INDEX.

207

Series VII.

INJURIES AND DISEASES OF THE LARYNX,
TRACHEA, BRONCHI, AND BRONCHIAL

,-®EB0)Sk OF THE LUNGS AND PLEURA.

./'V J/T\

7. INDEX TO THE SERIES.

• V ,, A.-THE LARYNX, TRACHEA, AND BRONCHI, (b

< ‘ •? > \ vs.

1. — Wounds ’and other mechanical injuries, 1, 2, 3. \

2. — Foreign bodies producing obstruction, 4, 5, 20. ' r

3. Diseases of the mucous membrane and submucous tissue.

(a) Oedema with acute inflammation, 6, 7, 8, 9, 10, 11, 12, 13, 11,

15.

(b) Crupous or diphtheritic inflammation, 16, 17, 18, 19 20

33, 34, 3o, 36.

0) Abscess, 11, 31, 37, 42.

(e) Slough, 38.

(/) Thickening and induration (chronic inflammation), 39, 40, 41 *
41a.*

4. — Diseases of the cartilages and connecting membranes, 40. 42, 43.

5. — Illustrations of laryngotomy and tracheotomy, 7, 8, 10 11 12

13, 15, 17, 18, 19, 20, 25, 42.

6— Entozoa, 44, 45.

7.— Dilatation of the bronchial tubes, 46, 47, 48, 63, 66, 99.

B.— BRONCHIAL GLANDS.

■ '■'HBONIC enlargement with infiltrations—

(«) Caseous, 49, 50, 51.

(D Pigmentary, 51, 52, 53, 54.

(r) Carcinomatous, 55.

C.-LUNGS.

Pneumonia, lobar.

(a) Red hepatization, 56, 57, 67.

\b) Grey hepatization (purulent infiltration) 58, 59.

^'"“Pneumonia, lobular.

(«> Primary, 60, 61.

(0 Secondary or pysemic, 62.

* Syphilitic.

208

INDEX.

[series VII.

3. — Pneumonia, chronic or interstitial, 63, 64, 65, 66.*

4. — Abscess—

(a) Primary, 67.

( b ) Secondary or pysemic, 68, 69, 70.

5. — Gangrene, 71, 72, 73, 74, 75.

6. — Acute or diffuse pulmonary tuberculosis, 76, 77, 78, 79, 80,

81, 82.

7. — Limited tubercular deposit, chronic, 83, 84, ‘ 85, 86, 87.

8. — Phthisis —

(a) Tubercular, 88, 89, 90, 91, 92, 93, 94, 95.

(b) Catarrhal, caseous or pneumonic, 96, 97, 98, 99, 100, 101, 102,

103, 104, 105, 106, 107, 108, 109.

9— Pulmonary hemorrhage, 92, 93, 116, 117, 118, 119.

10. — (Edema pulmonum, 120.

11. — Atelectasis pulmonum —

(a) Congenital, 121.

(b) Acquired, 122.

12. — Cabnification (from pressure), 123, 124, 125, 126, 141, 148, 149,

151, 157.

13. — Emphysema —

(a) Vesicular, 127, 128, 129, 130, 131.

( b ) Subpleural or interlobular, 131.

14. — Pigmentary infiltration, 100, 132, 133, 134.

15. — New growths —

(a) Carcinoma, 55, 135, 136, 137, 138.

(b) Sarcoma, 139.

16. — Entozoa, 44.

17. — Preparation from an ourang-utan, 140.

D.— PLEUKA.

1.— Acute pleuritis (diffuse recent exudation), 60, 123, 141, 142.

2 —Chronic pleuritis (thickenings and adhesions of old-standing and of
opposite surfaces), 143, 144, 145, 146, 147.

3. -Empyema or pyo-thorax, 148, 149, 150, 151, 152.

* Brown induration.

t Syphilitic.

SERIES VII.]

DISEASES OF THE LARYNX.

209

4. — Deposits, morbid growths, &c., connected with the tleuea and

SUBPLEURAL TISSUE —

(a) Fibroid, 153.

(b) Tubercular, 123, 1 54.

( d ) Pigmentary, 132, 155.

( e ) Calcareous, 150, 156.

5. — Perforation of pleura by rupture of vomic2e, 143, 149.

6. — Communication between pleura and bronchi, 157.

1. Fracture of the thyroid and cricoid cartilages in an a^ed Armenian
woman. These cartilages, the epiglottis, and the rings of the
trachea are seen to have undergone calcareous degeneration so
common at an advanced period of life, and are quite hard and
rigid. (Webbs Pathologia Indica, No. 395, p. 135.) (Pre-
sented by Professor R. O’Shaughnessy.)

A preparation showing the injuries inflicted upon the windpipe in
a case of attempted suicide by cut-throat. The epiglottis lias
been severed, together with the root of the tongue, the section
passing through the thyro-hyoid membrane. Death occurred
trom the subsequent inflammation and oedema of the rima Hot

/w^^ep?Lefi;ed-C0rd\ti0n °f which is sti11 t0 be observed.
(Webb s Pathologia Indica , No. 548, p. 135.)

“ Larynx of a cut-throat.” The incision has been made through

S® %r°;hy01d l membrane, severing the epiglottis, but leaving
the thyroid cartilage uninjured. &

‘ Portions of a ‘ Koi’ fish, which caused suffocation in a child bv

of thecal °dfld T tHe faUCfS-- The fish sliPPed into the mouth
of the child while he was playing with it. Tracheotomy was

Professors. B PartrilgoV0 h

The larynx of a native child, opened from behind, and showing the

lm‘>acted in the It is”SlAe

\Kutory of the case by Dr. Baillie. Kokan, an infant under one year
lsrr i r lro-uftt,to the natlve hospital on the 14th of August

1808 late at "‘gh , having showed the claw of a emb which

the aec“e,?t'VenBr % ^ Ab™‘ h"*» ™ elapsed S
c accxdent. Breathing was extremely difficult, and everv

spiration accompanied by a loud wheezing noise. I was about

open the trachea, and had divided the skin, when respiration

was found to have stopped. The foreign bodv seen P n n

:i~'S “V* WaS f°“nd- The portion of the

„ aaer e^l HeS B ‘li^ -

Zltz -fr.

epiglottis is hard and enormously swollen and so are all il 1°
about the uiottis ti.;« J ’ dnu so aie ah the parts

Oiottis. ibis great swelling has effectually closed the

'210

(EDEMA GLOTTIDIS.

[series VII.

larynx.” (Ewart.) Laryngotomy was apparently performed.
No history. ( Presented by Professor Allan Webb.)

7. The larynx and upper part of the trachea of a native male patient,

aged 32.

There is great oedema of the aryteno-epiglottidean folds of mucous
membrane, especially on the right side. Besides which, in the
fresh state, the mucous membrane of the larynx generally had
a dark gangrenous appearance, and was much softened. The
cricoid cartilage is completely necrosed and separated into two
pieces. In the opening into the windpipe,' made by the
operation, the cricoid cartilage and first two rings of the trachea
have been divided. The false vocal cords (and the mucous
membrane between the cords) are swollen and oedematous. The
lining membrane of the trachea much thickened and somewhat
roughened.

The patient died from acute suppuration (pysemic) and gangrene of
the lungs.

8. The larynx of a Mahomedan lad who was brought into hospital

in a moribund condition suffering from acute laryngitis, with
great difficulty of respiration and impending asphyxia. Laryn-
gotomy was immediately performed, but only proved temporarily
beneficial. On opening the larynx, at the post-mortem examination,
the rima glottidis was found greatly contracted, its margins highly
congested, swollen, and oedematous ; the under surface of the
epiglottis and the aryteno-epiglottidean folds participating in these
morbid changes. The trachea was healthy.

9. (Edema of the glottis supervening rapidly, and ending fatally in

a very short time, in a case of adynamic remittent fever. The
patient was a young Cabullee (male), aged 22. The aryteno-
epiglottidean folds and the mucous membrane investing the
arytenoid cartilages are seen to be greatly tumefied, and, in the
recent state, almost completely obstructed the glottis.

10. Acute oedema of the larynx. The mucous membrane on both

surfaces of the epiglottis, that of the aryteno-epiglottidean
folds, and that of the larynx as low down as the true vocal cords, is
swollen, much thickened, and of a pale whitish colour. So great
was the oedema that the rima glottidis was almost occluded, —
a mere chink. On the anterior aspect of the trachea, a little
to the right of the median line, is the incision made in the
operation of laryngo-traeheotomy. It is about an inch in
length, and cuts through the crico-thyroid membrane, cricoid
cartilage, and first ring of the trachea. From a native male
patient, aged 48. (For further particulars see “ Surgical
Fost-mortem Records,” vol. I, 1875, pp. 97-98.)

11. The larynx and trachea of a native (male), aged about 24 years,

who died from pneumonia following the operation of trache-
otomy. The latter was performed for the relief of acute laryn-
gitis. An abscess, the size of a walnut, had formed in the
loose cellular tissue on the left side of the crico-thyroid
articulation, from which, apparently by direct continuity of
tissue, the inflammatory process had spread to the interior of

SERIES Til.]

ACUTE LARYNGITIS.

211

the larynx. Moreover, the terminal filaments of the left
recurrent laryngeal nerve were traced (post-mortem) directly
into the abscess, and this would probably account for the
repeated attacks of suffocative spasm from which the patient
suffered, and which necessitated eventually operative interference.
Considerable portions of the cricoid and thyroid cartilages are
denuded of perichondrium, and there is unilateral inflammatory
oedema of the lining membrane of the larynx, extending from
the abscess to the upper margin of the left aryteno-epiglottidean
fold.

12. The larynx and a portion of the trachea showing acute oedema

of the aryteno-epiglottidean folds and lining membrane of
the larynx, as also the incision made through the cricoid
cartilage and upper two rings of the trachea in the operation
of laryngo-tracheotomy. The subject, a native boy, aged about
15, was a patient in hospital, under treatment for chronic
enlargement of the spleen and intermittent fever ; was very
weak and debilitated. The laryngeal oedema set in quite
suddenly on the evening of the 3rd June 1876, and within
an hour and a half threatened suffocation. The operation was
at once performed, and gave immediate relief. The patient
survived for 42 hours, and then died from simple exhaustion.

13. A preparation exhibiting (1) acute oedema of the mucous mem-

brane of the larynx, especially of the aryteno-epiglottidean
folds and sacculus laryngis ; (2) the opening made into the
windpipe during life for the operation of laryngotomy, situated
quite below the seat of obstruction. The patient, Ram Dass,
a Hindu, aged 25, died from acute bronchitis after the operation.
(See further, “ Surgical Post-mortem Records,” vol. I, 1S79
pp. 637-38.)

14. Acute oedema of the epiglottis and aryteno-epiglottidean folds.

The former is very rigid and swollen, especially its left half,
which, moreover, along the outer edge of the cartilage is ulcerated’
the ulcerated portion being about lour lines in length and two
lines in depth. The aryteno-epiglottidean folds and the mucous
membrane investing the arytenoid cartilages are greatly swollen,
oedematous, and were, in the fresh state, of a livid purple colour.
Along the superior margin of the right fold are two small
shallow ulcers, each about the size of a split pea. The mucous
membrane ol the rest of the larynx was found a little swollen
and vascular ; the vocal cords unaffected. From a native
male, aged about 40, who was brought to the hospital in a
moribund condition, and died within thirty hours of admission.
There was acute pericarditis and double acute pleurisy.

J5. A very marked example of acute oedema of the larynx. The
whole of the epiglottis is enormously swollen, vascular, and
rigid. The mucous folds reaching from it to the arytenoid
cartilages are greatly thickened and foreshortened, and the lining-
membrane of the larynx generally is thickened and puffy. The
orilu-e ot the glottis was found almost completely obliterated
.tracheotomy was performed during life, but the patient, a native

212

1)1 PIITH EllITIC LAE YNGITIS.

[SERIES VII.

16.

17.

18.

19.

(male) agecl 20, died from hypostatic pneumonia following the
operation. ( See further, “Surgical Post-mortem Records,”
vol. 1, 1S80, pp. 781-32.)

Larynx of a child showing the remains of a filmy croupal mem-
brane and considerable oedema of the aryteno-epiglottidean folds.
No history.

A preparation of the fauces, larynx, and trachea of a European,
aged 33, who died from diphtheria. Both tonsils are swollen,
superficially ulcerated, and semi-gangrenous. The epiglottis and
aryteno-epiglottidean folds of mucous membrane are highly thick-
ened and cedematous. A leathery false membrane invested these
parts, reaching from the fauces into the larynx, and downwards
to nearly the bifurcation of the trachea. Fragments of this
membrane are still to be seen, though much of it lias disappeared
under maceration. Laryngotomy was performed eleven hours after
admission into hospital on account of urgent dyspnoea. The
opening into the windpipe is indicated by a curved hollow glass
tube. The patient was much relieved by the operation, but
died from general exhaustion about twelve hours after its
performance.

Specimen showing the fauces, larynx, trachea, and lungs of a
European child, aged four years, who died from diphtheria
after an illness of four days. The tonsils, epiglottis, the whole
of the inner surface of the larynx, and the upper part of the
trachea were found covered with a well-tormed membrane,
the shreddy remains of which still exist. Asphyxia being
imminent, tracheotomy was performed (the opening is seen
in the preparation), but the child never rallied. The lungs
and bronchi were found highly congested, ol a vermillion red
colour in the recent state. “ Although the vocal cords are
covered and obscured by false membrane, the child could arti-
culate to within an hour and a half of death.” (Ewart.)

The fauces and larynx of a European male patient who died in
hospital from diphtheria. Both tonsils are swollen and ulcer-
ated ; the right is covered by the shreds of a thick, leathery,
fibrinous membrane, which, investing also both surfaces ol the
epiglottis, entered the larynx, and, in the fresh state, could be
traced throughout this cavity, overlying the mucous membrane.
It was thicker on the right than on the left side, and was
continued downwards as a thin pellicular film into the trachea
and both bronchi. The right pillar of the glottis and the right
vocal cords are much swollen and cedematous, and the rima
glottidis greatly contracted in consequence. On the anterior

made

during

life

rspect of the preparation is the opening

the crico-thyroid cartilage and first two rings ol the

further, “ Surgical Post-

20.

through

trachea (laryngo-tracheotomy). (See fur
mortem Records,” vol. 1, 1879, pp. 555 -06.)

A preparation showing the post-mortem appearances ol the
fauces, trachea, and lungs in a fatal case ol diphtheria. The soft
palate and tonsils are seen partially invested by a thick sloughy
exudation (false membrane), which can be peeled oil pretty

3EU1E3 VII.]

DIPHTHERIA.

213

readily with the forceps. The uvula is completely covered by
the same. Both tonsils are ulcerated. The mucous membrane
at the base of the tongue, and that of the pharynx generally, has
a dark purple congested appearance.

The epiglottis and the aryteno-epiglottidean folds are much swollen
and thickened, and here and there invested by the remains of a
shreddy membrane. The whole of the interior of the larynx
is lined by the same. At the centre of the anterior surface of
the trachea is the opening made into the windpipe during life.
The cricoid cartilage and first three rings of the trachea have
been cut through. Below this opening the membranous exuda-
tion is again seen forming a complete mould or cast of the
lower end of the trachea. It is about two lines in thickness,
and of the colour and consistency of a decolourised cardiac clot.
Is loosely adherent to the inner surface of the trachea, and can
readily be detached with the forceps. The mucous membrane
beneath it presented (in the recent state) a raw-looking,
roughened, minutely ecchymosed condition. This same mem-
brane extends into the bronchial tubes, and may be tracked into
their minute branches,— almost to the periphery of the lungs.

Portions of the diphtheritic membrane examined microscopically were found to
consist of closely packed, very numerous leucocytes, with one, two, or three
sharply -defined nuclei, red blood-corpuscles, blood-colouring matter, a large
number of free nuclei (bioplasts), and here and there a few altered and
degenerate epithelial cells. All these cell elements were held together by
finely filamentous, granular, basis-substance, evidently fibrin or fibrinous
in character.

Obstructing completely the left bronchus, and extending for about an
inch into the trachea, is a narrow twisted plug of bandage-cloth,
which, being employed for occasionally cleaning out the tracheo-
tomy-tube, was accidentally sucked into the windpipe when
being thus used by the brother of the patient. Every endeavour
was made to remove this foreign body, but unsuccessfully, the
boy dying asphyxiated while manipulations for this purpose
were being carried out. Both lungs, but particularly the left,
were found collapsed. Their surfaces, as well as the deeper pul-
monary tissue, exhibited patches of ecchymosis and minute
blood extravasations. The subject was a native boy, aged about
ten years. Was admitted into the hospital on the 18th July
1878. Tracheotomy was performed the same afternoon. He died
suffocated on the 21st July 1878.

21. Superficial ulceration of the whole of the mucous membrane of the

larynx, including the false vocal cords. On the right side
perforation, with the formation of a small abscess between the
cricoid and thyroid cartilages, has taken place. The perichondrium
investing the latter has been removed over a limited area.

22. “ Larynx of Owen, 0., admitted 8th February 1864, died on 16th

March 1864, with symptoms of laryngeal phthisis. The larynx
is opened along the median line on the posterior aspect.”

The interior of the larynx exhibits extensive ulceration of the under
surface of the epiglottis, of the vocal cords — the superior of

214

TUBERCULAR LARYNGITIS.

[series VII.

which have been almost entirely destroyed — and of the lining
membrane of the upper part of the trachea.

23. “ Larynx of G. L., a Swede, who died of pulmonary and laryngeal

phthisis.” There is extensive ulceration of the interior of the
larynx, laying bare the arytenoid cartilages. The vocal cords
are involved, and the mucous membrane immediately below them
deeply excavated.

24. Tubercular ulceration of the larynx. The mucous membrane

lining the thyroid cartilage, from the base of the epiglottis to
the vocal cords, and including the upper margin of the “ false ”
cords, is seen pitted and ulcerated, the disease extending on the
left side into the sacculus laryngis, and adjacent portion of the
“ true ” vocal cord. Lower down, in the trachea, may be seen
two or three sharply-defined rounded ulcers, involving the whole
thickness of the mucous coat. They are indicated by small glass
rods. From an East Indian, aged 48, who died in hospital.
He was much troubled “ with fits of spasmodic dyspnoea.”

25. E xtensive ulceration — probably syTphilitic — of the interior ol the

larynx. The preparation shows a deep excavated ulcer occupying
the centre and left half of the mucous membrane lining the
thyroid cartilage, the latter being partially softened, and a
portion of it necrosed. On the anterior aspect is seen the open-
ing made in the operation of laryngo-tracheotomy for the relief
of urgent dyspnoea, which, in this case, suddenly supervened.
The patient, a European, aged 44, died from broncho-pneumonia
on the eighth day after the operation.

26. Syphilitic ulceration of the larynx and trachea. There is a little

superficial roughening of the mucous membrane of the larynx,
but the disease really commences at the lower border of the
thyroid cartilage, and thence extends downwards. The ulcer-
ation affects the left half of the tracheal tube more than the
right. A series of deep, transversely-placed ulcers are seen
here, involving the mucous and submucous tissues, and exposing
the cartilaginous rings. The patient was aged 35. He suffered
from “distressing asthma during life.” Marked syphilitic
thickening of the capsule of the liver, and some nodular
growths in the substance of this organ, were found on post-mortem
examination. ( Presented by Dr. MacLeod.)

27. Laryngeal phthisis. The larynx of a patient who had long

suffered from huskiness of voice, and was greatly emaciated. . The
right half of the laryngeal cavity is seen to be principally
affected. Both vocal cords on this side are entirely destroyed—
are represented only by thickened tuberculated tissue. The
right aryteno-epiglottidean fold has been perforated ; an opening,
rather larger than a 4-anna piece, and with an irregular
indurated margin, leads into a cavity the size of a hen’s egg,
situated external to the larynx. This cavity is bounded behind
by the cricoid and right ala of the thyroid cartilage, externally
and in front by the thyro-hyoid membrane, and above by the
epiglottis and roof of the tongue. It was half filled with recent,

SERIES VII.]

SYPHILITIC LARYNGITIS.

215

soft, blood-coagulum, and contained also much muco-purulent
offensive fluid. Its walls are ragged and composed of shreddy,
flocculent, disorganising tissue. At the bottom of this cavity
was found the superior laryngeal branch of the superior thyroid
artery, laid open by ulceration. The patient died suddenly from
severe ha3moptysis, the blood no doubt issuing from the vessel
above referred to. The laryngeal thickening and ulceration is
tubercular in character.

A small deposit of partially caseous tubercle was found at the posterior margin of
the superior lobe of the right lung Diffusely disseminated throughout
both lungs were a very large number of isolated or circumscribed, dark-red
nodules, varying in size from a pea to a hazel-nut (pulmonary apoplexy).
Both bronchi were filled with bloody frothy fluid. A little fluid blood was
also found in the stomach, the mucous membrane of which was healthy ;
and a few pale, circular, characteristically tubercular ulcers in the lower
third of the ileum. ( Presented by Professor D. B. Smith.)

28. Larynx exhibiting extensive tubercular ulceration and thickening
of the mucous membrane, and destruction of the false vocal
cords. The disease involves the entire lining membrane, from
the under surface of the epiglottis (the margins of which are
indurated and rigid) to the level of the true vocal cords.
The ulceration is deeper on the left than on the right side, and
affects the mucous membrane of the trachea also, on that
side, for an inch below the cords. — From a Mahomedan (male),
aged 30, who died from phthisis.

29. Syphilitic laryngitis in a young native female. The epiglottis is

abnormally rigid ; the mucous membrane on its under surface
superficially ulcerated. The aryteno-epiglottidean folds are
thickened, and the false vocal cords partially destroyed. {Pre-
sented by Professor Id. C. Cutcliffe.)

30.

31.

Phthisis laryngea. The larynx and trachea of a Europeon sea-
man who died from pulmonary phthisis. Both true and false
vocal cords on the right side have been completely destroyed by
tubercular ulceration, which extends deeply into the saeculus
aiyngis on this side. The mucous membrane of the trachea
presents numerous small, shallow, superficial ulcers, none of
them much larger than a hemp seed.

Syphilitic laryngitis. The right half of the epiglottis, and of the
ining membrane of the larynx, as far as the right false vocal
con , present a greatly thickened and ulcerated condition, which
a so extends to the cul-de-sac between the thyroid cartilage
am p larynx on the same side. This space was occupied by
lowmsh, thick, grurnous-looking secretion, which could
a so be traced throughout the larynx and trachea into the
ri^ 1 bronchus, the latter being almost occluded by the
same. I he arytenoid cartilage on the. right side is thickened
ana rigid The right aryteno-epiglottidean fold has been com-
pletely destroyed. The glottis was greatly encroached upon,
and reduced to a mere sHt. The mucous membrane below the
undl t 18 ’f. * 'y', (There "'as 1 "Ul-raai kcd cicatrix on the

peois’ aud the giaujs i“ b°th groi,,s

216

TUBERCULAR LARYNGITIS.

[series VII.

The patient was a Hindu, aged 53, by occupation a blacksmith. ( See
further, “ Surgical Post-mortem Records,” vol. I, 1875, pp.
215-16.)

32. The larynx of a Chinaman, aged 28, who died from tubercular

phthisis. On the under surface of the epiglottis there are
several sharply-defined shallow ulcers. The posterior halt of the
left true vocal cord, and the adjacent portion of the false cord
above it, are deeply ulcerated, and there is a deep, punched-out
looking ulcer at the retiring angle of the thyroid cartilage, near
the point of junction of the vocal cords anteriorly. A few small
superficial ulcers can be traced into the trachea. (“ Medical
Post-mortem Records,” vol. Ill, 1879. pp. 81-82.)

33. Larynx showing extensive tubercular ulceration of the mucous

membrane from the under surface of the epiglottis to below
the vocal cords. The epiglottis itself is swollen and rigid.
There is superficial ulceration of both aryteno-epiglottidean folds,
more marked on the left than on the right side. The lining
membrane of the larynx is most deeply affected at the anterior
angle of the thyroid, near the junction of the vocal cords.
Superficial patchy ulceration extended all through the trachea.
From an East Indian, J. M., aged 30, who died in hospital from
pulmonary phthisis and enteritis. (“ Medical P ost-mortem
Records,” vol. Ill, pp. 191-92.)

34:. The larynx of an East Indian (male), aged 45, who died
from phthisis, exhibiting an oval-shaped ulcer, rather larger
than a 2-anna piece, on the under surface of the epiglottis.
The edges of the ulcer are somewhat hard and elevated, the
base rough, excavated, partially exposing the cartilage. It is
undoubtedly tubercular.

35. Syphilitic ulceration of the larynx. The mucous membrane on
the inferior surface of the epiglottis, and that lining the larynx,
especially on the right side, as low down as the true vocal
cords, is seen eroded and ulcerated. The right false vocal cord
has been completely destroyed. Under the epiglottis, near its
right margin, is a deep excavation, the size of a split pea,
exposing the cartilage. Its edges are sharply defined and a
little thickened.— From a European male, aged 39.

36 Tubercular ulceration of the larynx, from a native male, aged 2o,

brought to the hospital in a moribund condition, and who died
within twenty-four hours of admission. The right half of the
epiglottis has been entirely destrdyed. The cartilage is exposed,
and the glosso-epiglottidean fold of mucous membrane presents
an irregular-outlined ulcer about the size of a 2-anna piece.
The aryteno-epiglottidean folds are thickened and oedematous.
The mucous membrane of the whole of the larynx is rough,
granular, and ulcerated ; this condition extending downwards to
the false vocal cords, destroying them completely, and also the
posterior half of the right true vocal cord. (“ Medical Post-
mortem Records,” vol. Ill, 1880, pp. 605-606.) _

37 “ Abscess between the crico-arytenoid muscle and posterior surface

of the cricoid cartilage. The latter is denuded and slightly
eroded. ” (Colles.) ( Presented by Professor Chuekerbu tty.)

SERIES VII.]

CHRONIC LARYNGITIS.

217

38. Acute laryngitis wit.h sloughing of the mucous membrane lining the

upper half of the inner surface of the thyroid cartilage, including
the false vocal cords, and portions also of the true cords. From
a native male, aged 30, who died in hospital. (See further,
“Surgical Post-mortem Records,” vol. I, 1878, pp. 491-92.)

39. Larynx of a boy showing thickening of the epiglottis, aryteno-

epiglottidean folds, and mucous membrane of the larynx above
the true vocal cords, the result of chronic inflammatroy changes.
No history. ( Presented by Dr. Chuckerbutty.)

40. The larynx of a patient who died in hospital. The epiglottis,
aryteno-epiglottidean folds, and mucous membrane of the larynx
generally, are much thickened. There is considerable ulceration
of the posterior and right wall of the larynx. A large portion of
the thyroid cartilage is exposed, denuded of perichondrium, and
necrotic. The mucous membrane of the trachea, in the recent
state, was lividly congested.

41. Chronic syphilitic laryngitis. The epiglottis is somewhat rigid

and thickened. The lining membrane of the larynx, on its
anterior aspect, and on either side of the median line, is ulcer-
ated. The ulcers are sharply defined, each about the size of a
2-anna piece, and involve the false vocal cords. The true
vocal cords are unaffected, and the trachea healthy. The patient,
a native male, aged 35, gave a history of having had hard chancre
about three years previously, followed by “ secondaries.” His
condition improved much under specific treatment ; but, while in
hospital, he was attacked with acute pericarditis, from which
he died. ( See further, “ Medical Post-mortem Records,” vol. I,
1875, pp. 729-30.)

41a. Chronic syphilitic laryngitis and pharyngitis. The mucous
membrane of the pharynx presents here and there an irregularly
thickened, cicatricial condition. The left aryteno-epiglottidean
fold is drawn outwards and fixed to the outer wall of the
pharynx ; a puckered cicatrix existing here. On the same side,
the left half of the epiglottis is deeply fissured and rigid. The
mucous membrane of the larynx is superficially eroded and
thickened as far down as the false vocal cords, especially on the
left side. Below this, the true vocal cords are thinned and
yellowish, and the left cord shows a transverse splitting with
separation of a portion of its structure about a line in thickness.
The trachea is healthy.

From a native male patient (Bhulloo), aged 25, who died in hospital.
There was great difficulty experienced in swallowing, especially
fluids ; and almost complete aphonia. (See further, “ Medical
Post-mortem Records,” vol. Ill, 1880, pp. 737-38.)

42. The larynx and trachea of a native male patient, aged 26, upon
whom the operation of tracheotomy was performed on admission
into hospital in a suffocated condition. The incision in the
trachea is seen to have divided the upper six rings. The cause
of the obstruction was found on post-mortem examination to be
an abscess, the size of a pigeon’s egg, situated between the larynx
and pharynx (see preparation^), and surrounding the posterior

218

NECROSIS OF CARTILAGES.

[series VII.

half of the thyroid cartilage, which has almost completely necrosed.
This abscess extends laterally for a short distance between the
superior and middle constrictors of the pharynx, and by its
pressure inwards and forwards must have greatly diminished the
rima glottidis.

43. A preparation exhibiting necrosis of the cricoid cartilage. From

a Hindu, aged 32, who was admitted into the Mayo Hospital
with symptoms of urgent dyspncea, and died three hours after-
wards. There was no external swelling of the throat, but pain
complained of when the larynx was manipulated. No congestion,
ulceration, or deposit could be discovered on examination of the
fauces. No previous history of laryngitis or of syphilis could be
ascertained, only the statement that there had been “fever”
with dyspnoea for fifteen days. There were line crepitant rales
at the bases of both lungs and much dulness on percussion here,
so that, although tracheotomy was thought of, the operation did
not promise any relief owing to the embarrassed condition of the
lungs, and was therefore not performed.

On post-mortem examination “ an abscess was found round the cricoid
cartilage, and, on probing, necrosis of the cartilage itself was felt.
There were a few patches of congestion of the mucous membrane
below it ; the posterior and lower parts of both lungs were
hepatized.”

In the preparation the posterior half of the cricoid cartilage is seen
isolated, rough, bare, and completely necrosed. The mucous
membrane of the larynx, and especially that investing the
arytenoid cartilages, is swollen and oedematous. No ulceration
or thickening of the vocal cords. ( Presented by Dr. Cayley,
Mayo Hospital, Calcutta.)

44. A preparation showing perforation of the trachea, and the migra-
tion of lumbricoid worms (A. Lumbricoides) from the oesophagus
into the bronchi and left lung. A large, irregular-outlined
opening, with ragged margins, is observed in the oesophagus just
above the tracheal bifurcation, through which four lumbrici have
passed, and may be seen here, coiled upon each other and
extending into the bronchi. A second small perforation of the
oesophagus has taken place about two inches higher, and through
it a solitary worm has made its way into the apex of the left
lung, which appears to have been firmly united by old pleuritic
adhesions to the sides of the trachea and oesophagus in this
situation. No history. ( Presented by Professor Allan Webb.)

45. “ The lungs and air- passages of a Hindu subject from the dissecting

room. A globular cyst is seen connected to the exterior, but
not communicating with the interior of the right bronchus near
its origin, or at the bifurcation of the trachea. The wall of the
tumour is thin and translucent. Its contents are semi-solid,
filling the cavity of the cyst, which is as large as a small (hen’s)
egg. ” (Ewart.)

The pulmonary tissue behind the right bronchus is hollowed ouc for the
reception of this cyst. The right bronchus is much narrowed

SERIES VII.]

DILATATION OF BRONCHI.

219

46.

47.

48.

49.

151.

50.

and compressed, the left proportionately dilated. The cyst
contents are creamy and sebaceous-like,— represent most probably
the remains of an old and degenerate hydatid cyst. ( Presented
by Mr. Vanderstratten.)

Cylindriform dilatation of the bronchial tubes, from a case of
chronic phthisis, — a European soldier (Private J. Robinson,
Her Majesty’s 94th Regiment). The tubes present uniform
dilatation of their canals and thickening of their walls. The
mucous lining is rough, thrown into ridges and folds. The
pulmonary tissue is much condensed from chronic inflammatory
changes ; is filled with small caseous nodules, and exhibits
numerous small, irregular-outlined excavations, into some of
which the dilated tubules may be traced. The interlobular
connective tissue is everywhere much hypertrophied, forming
dense, firm, opaque-white or greyish fibrous bands. The
pleura is also throughout thickened. (Webb’s Pathologia Indica,
No. 1348, page 132.) ( Presented by Dr. Mouat, Inspector-

General of Madras.)

A portion of the left lung showing dilatation (cylindriform) of
the bronchial tubes, thickening of their walls, and roughening
of the lining membrane. These changes are associated with
chronic phthisis of the lungs, i.e. consolidation, caseous and
“pneumonic,” numerous small excavations, and hypertrophy
with much pigmentation of the interlobular connective tissue.
(Webb’s Pathologia Indica, No. 744, page 134.)

A portion of the left lung showing dilatation of the bronchial
tubes, chiefly in the form of bulbous terminal expansions.
Taken from a native woman, aged 50, who had suffered for
several years from persistent bronchial catarrh.

Enlargement with caseation and pigmentation of the bronchial
glands. One gland, situated just below the bifurcation of the
trachea, is as large as a pigeon’s egg. The mesenteric glands
were similarly affected.— “ From a young Hindu
(Webb’s Pathologia Indica, No. 1410, page 140.J

Enormous enlargement and caseation of the bronchial glands
surrounding the roots of the lungs, and occupying the anterior
mediastinum. The majority are firm, of a yellowish-white
colour, and cut like cheese. They are also marbled irregularly
bv daik pigitient matter. Some of the glands, however have
undergone softening, and in two instances this seems to have
led to ulceration and perforation of the trachea (at the point
of bifurcation), and of the right bronchus (about half an inch
from its origin). The former opening is rounded ; the latter
irregular in outline ; their margins are soft and shreddy • and
through each is seen projecting a little fungous mass— the
softened cheesy material of the glands. There is no history of
the case on record. ( Presented by Professor Edward Goodeve.)

Caseous degeneration of the bronchial glands, combined with much
granular pigmentary infiltration. The lungs are said to have
contained “ an excessive deposit of pigmentary substance.”

woman.

220

DISEASES OF BRONCHIAL GLANDS. [seeies vii.

52.

53.

54.

55.

56.

58.

59.

60.

61.

Greatly enlarged and very darkly pigmented bronchial glands,
found, on post-mortem examination, surrounding the loots ot
the lungs in a case of catarrhal phthisis. ri he patient was a
native male, aged GO, who died in hospital.

Enlarged, pigmented, and incipientlv cheesy bronchial glands.—
From a native male, aged 25, who died from fibroid phthisis.

(“ Medical Post-mortem Records,” vol. Ill, 1880, pp. ooo-ob.)
Several enlarged bronchial and tracheal lymph-glands, showing
more or less diffused dark pigmentation.— From a native male,
ao-ed 20, who died from non-tubercular phthisis (chronic
catarrhal pneumonia), with extensive consolidation and pigmen-
tation of both lungs. (“ Medical Post-mortem Records, vol. Ill,

1880, pp. G67-68.) . ,. ,

Portions of lung substance and sections from several bronchial
.lands infiltrated with dark (melanotic) cancerous deposits.-
From an East Indian (male), aged 44, m whom the disease was
diffusely distributed— affecting the liver, brain, kidneys, bones,
&c. (See further, “ Medical Post-mortem Records, vol. 1,

1 S78 v) 16)

A section from a hepatized lung in pneumonia. “ Disease in first
«tao-e” The lung tissue is of greyish colour, probably fiom
a^e the colouring matter having been washed out. Many of the
alveoli are seen empty, the effect also of prolonged m^tum^
but in others, a pale-yellowish, fibrinous mate ml fills these
spaces, and is also blocking several of the smaller broncliu .

( Presented by Professor Allan Webb.) .

Idie right lung of a native male patient, aged 2o, who died in
hospital from pneumonia. The whole lung is '
pale-red in colour, finely granular on section , soft and ^ friabl^
and exudes on pressure thick, muco-purulent, viscid Uuia
(“ red hepatization”). The lung weighs 42 ounces.

Grey hepatization of the bases of both lungs, portions ot which
together with the heart and aorta, have been preserved. H e
pulmonary tissue is semi-solid, and at the same time in parts
tattered and disorganised, of greyisb-wlnte colour, and consi -
‘ t-lv rno-mented. The heart is covered with recent lymph
fromacito pericarditis. Its cavities (especially the right ventricle)
are occupied by large, firm, decolourised, fibrinous coagula,

Sectionsdrom the lung, illustrating the physical appearances and
general morbid anatomy of lobar pneumonia in the stage of

“Tim' thorn Hof0;! native child, showing complete pneumonia

:?;r n (cdiS1.)

twelve years. The patches of pulmonary consolidation me most
t 1111 in the right Inner, towards the posterior margin and
S of which sevetl maybe seen, varying in size from a hen s
egg to a nutmeg. They are all situated superficially, 3

SEMES VII.]

PNEUMONIA.

221

beneath the pulmonary pleura ; are distinctly circumscribed ;
of a dark purple colour (in the fresh state) ; soft, and exude on
pressure a little thin sanguineous serum. (Nee further, “Medical
Post-mortem Records,” vol. I, 1875, pp. 789-90.)

62. A section from the lower lobe of the left lung of a native boy,

aged 12 years, who died in hospital from pyiemia associated
with gangrene of the right foot. The preparation exhibits a
circumscribed patch of lobular pneumonia, about the size of
half a walnut, of a pinkish-grey colour from incipient softening
and suppuration. There are also several smaller, wedge-shaped,
dark-red infarctions. All are situated at the periphery (posterior
margin) of the lung, and just beneath the visceral pleura, which
is brightly injected, and coated with a little recent fdmy
lymph. There were multiple abscesses in both kidneys. ( See
further, “ Medical Post-mortem Records,” vol. Ill, 1880,
pp. 623-24.)

63. Right lung showing the characters of chronic interstitial
pneumonia. The whole lung is invested by a thick “ false
membrane,” which united it firmly to the ribs, intercostal
spaces, and diaphragm. There is considerable condensation of
the upper half of the superior lobe, with much thickening of the
inter-alveolar and interlobular connective or fibrous tissue, and
pigmentation of the pulmonary substance. All these conditions
are again well marked in the lower lobe, and associated with
enlargement, dilatation, and thickening of the bronchial tubes.
The terminal bronchules have, on the contrary, thin transparent
walls. The whole of this lobe is semi-solid, firm, and of a
greyish-red colour. — From an East Indian male, aged 25, who
died in hospital. (“ Medical Post-mortem Records,” vol. II,
1877, pp. 647-48.)

64. Chronic pneumonia of the left lung. The whole organ is unusually
firm and solid. The bronchial tubes are thickened and dilated,
especially in the superior lobe, and associated with much general
libroid thickening, condensation, and pigmentation of the inter
stitial connective tissue of the lung. There arc also numerous
small scattered cheesy deposits, — several in a state of softening,
a f0w partially excavated. — From a native male, aged 30.

165. Interstitial pneumonia. A portion of the left lung of a native
male patient, aged 40, who died in hospital. There is much
condensation of the pulmonary tissue, produced partly by chronic
pneumonic (caseous) changes, partly by increased thickening
and development ol the interlobular and inter-alveolar connective
tissue. I he latter forms broad, white, fibrous bands, intersecting
the lung substance in various directions. At the upper part
are three or four small circumscribed cavities (vomieie). The
pulmonary tissue generally is very darkly and abnormally niir-
mented. 5

<66, Brown induration of the lung. A portion of the left lun°- (super-
ior lobe chieHy) preserved. The pulmonary tissue is voa-y much
condensed, hard, and firm ; throughout abundantly and very
aark!y pigmented. The bronchial tubes are dilated Tlie

222

ABSCESS OF THE LUNG.

[series VII.

interlobular and inter-alveolar connective tissue, and the visceral
pleura much thickened. There are a few scattered caseous
and pigmentary concretions. Thick inspissated mucus occupied
the terminal bronchules. — From an East Indian (male) patient,
ao-ed 15, who died from chronic bronchitis. The right cavities
of the heart were greatly dilated and hypertrophied. The liver

67 Pneumonia, terminating in abscess, ihe preparation exhibits an

abscess-cavity, capable of holding a duck s egg, situated at the
posterior margin of the upper part of the lnfenoi lobe of the
left lull0". It was filled with tlnn, highly offensive, i eddish,
purulent5 fluid, and its walls are composed of shreddy, disorgams-
ino- tissue. Where it approached the surface the pleura was
inflamed and thickened. The rest of this lobe is in a state of
“red hepatization.” From a Hindu aged _25 who died in
hospital. (“ Medical Post-mortem Records, voi. Ill, lobu,

68 Both ° lungs' showing small pysemic abscesses situated at the

surface, and invested by circumscribed patches of pleuntic
exudation. The posterior surfaces of both organs are almost
entirely covered with “ yellow false membranes, which can easily

“ The liver showed a number of abscesses throughout its stiuc-

Taken Rom a native male, aged 22, admitted into hospital with contused
and lacerated wounds of three fingers of the right hand. The
middle finger was amputated through the metacarpal bone- ^
few days after, the wound became dry and ceased to granulate.
The divided end of the metacarpal bone (around which an abscess
holding about a drachm of pus had formed) protruded from the
upper end of the wound, bare and dry. The patient had fever,
with exacerbations at night, gradually increasing iij ;
rigors also, on three successive days, followed by jaundice
and extensive pleuro-pneumonia. He sank 12 days ; a cr i
operation.” (Colles.) ( Presented by Professoi J. A. Puiefoy

69 MultTpirTmaff0 pysemic abscesses of the left lung, from a Hindu
boy, aged about 15, who died from erysipelas of the face, with
intercurrent blood-poisoning. This lung exhibits at its surface^
numerous dark-purple ecchymoses and small cncumscu
abscesses. The majority of the latter are the size of a pea or
little larger and are all placed quite superficially, ihe deeper

portions of the lung substance are pale, anaemic, and somew a
deficient in crepitation. „ “ false-

The lower lobe is covered at its base and outer margin by a thick <
membrane.” The immediate base, for about halt an inch,
consolidated and soft (pneumonia). The upper half of tto
lobe is especially infiltrated with multiple small abscesses.
(Presented ly Professor H. C. Cuteliffe, r. 11.0.3., re.) ,

The bases oi both lungs infiltrated with small e.rcumscrdied
pysemic abscesses and softening infarctions.— From a nati

70.

SERIES VII.]

GANGRENE OF THE LUNG.

223

male, aged 30, who died from pyaemia after compound com-
minuted fracture of the left foot, with subsequent suppu-
ration of the soft parts, &c. ( See further, “ Surgical Post-mortem
Records,” vol. I, 1880, pp. G73-74.)

71. “ Gangrene of the whole of the lower lobe of the left lung, which

is seen to be undergoing separation as a slough. The line ot
demarcation is conspicuously displayed. The right lung is
greatly congested, particularly in its superficial portions of the
parenchyma. The left lung is enveloped by pleura thickened
by inflammatory exudation. The heart is fatty.” (Ewart.)
{Presented by Mr. Minas.)

72. Gangrene of a large portion of the superior lobe of the right

lung, producing great disorganisation and excavation of the
pulmonary tissue of this part. — From Martin Bryan, European
patient, who died in hospital. {Presented by Professor Chucker-
butty.)

73. Gangrene of the lung. The superior lobe of the right lung is

exhibited, with a patch of gangrenous softening at the upper
part of its posterior margin. The pulmonary tissue is broken
down, pulpified, shreddy (was highly foetid and offensive), for
a space about the size of a hen’s egg. This part is surrounded
by consolidated, pus -infiltrated lung-substance, and had, in the
recent state, a dark-greenish colour. Three similar but smaller
patches of gangrene were found in the lower lobe, and a larger
one at the base of the left lung. — From a greatly emaciated
native (male), aged 35, who died from chronic dysentery and
starvation. {See further, “ Medical Post-mortem Records,” vol. I,
1875, pp. 537-38).

74. Gangrene of the lung. The right lung is preserved. The whole

of the middle lobe is gangrenous ; is soft, shreddy, completely
disorganised ; of dark-greyish colour, and very putrescent (in
the fresh state). — From a Hindu (male), aged 40, who died in
hospital. (“ Medical Post-mortem Records,” vol. II, 1878,
pp. 945-40.)

75. A preparation showing gangrene of the upper half of the superior

lobe of the right lung. The entire thickness of the pulmonary
tissue at this part presents a dark ash-grey colour ; is exceedingly
soft and shreddy ; and exhaled a peculiar putrid odour. Large
portions have partially separated in the form of sloughs. — From
a Frenchman, by occupation a hair-dresser, aged 34, who died
in hospital. {See further, “ Medical Post-mortem Records,”
vol. Ill, 1879, pp. 123-24.)

' 76. Acute miliary tuberculosis of the lung. A portion (chiefly the
superior lobe) of the left lung is exhibited. The pulmonary
tissue is thickly infiltrated with minute rounded hard granules,
like small sago-grains. They are also seen beneath the visceral
pleura, where the latter is not thickened and opaque. The
granulations are so diffusely and abundantly distributed that the
lung tissue is rendered abnormally dense and solid,— the air-cells
and blood-vessels compressed, and, in parts, obliterated. The
great majority of the granules are in a state of incipient caseation.

224

PULMONARY TUBERCULOSIS.

[series VII.

77.

78.

79.

80.

81.

82.

The opposite (right) lung was similarly affected, and also the
rio-lit kidney. ( Presented by Professor Edward Goodeve.)

« Both lungs of a native child, two years old, thickly studded with
small masses of tubercle, each about the size ol a pin s head.
The deposit has the microscopic characters of tubercle. A
portion of the ileum showed tubercular ulceration. Neither
the child nor its mother (a prisoner) exhibited any indications of
syphilitic taint.” (Colles.) ( Presented by Dr. Fawcus, Alipore

A beautiful specimen of acute miliary tuberculization ol the
lung. The organ is enlarged and heavy. Beneath the pulmon-
ary pleura myriads of minute rounded, sago-grain-like granu-
lations are seen, and yet more distinctly in the sections which
have been made through the pulmonary tissue. A very large
number of these granules are solitary, i.e., disposed singly, but
there are also groups of three, four, or more. No excavations
and no caseous^ deposits are observed. The disease has been a
rapid and acute one. ( Presented by Professor Chuckerbutty.)

A portion of the right lung, showing diffuse miliary tuberculosis,
much of it in a state of incipient cheesy metamorphosis. No

Both°lungs diffusely infiltrated with miliary tubercles, the right
also having a cavity at its apex, about the size of a walnut.
The tubercles are for the most part in a. state ol incipient case-
ation.—From a native male, aged 16.

The right lung diffusely and very thickly infiltrated with miliaiy
tubercles ; some incipiently caseous, but the majority recent,
pale-grey, hard, and resistant.— From a native female, aged 8,
who died from general tuberculosis.

The upper half of the superior lobe of the left lung M
large grey granulations and a few cheesy deposits. I he inter-
alveolar and interlobular connective tissue is irregularly thick-
ened.

Both lungs were similarly affected. Sections made for microscopical examination
show well-marked broncho-pneumonic lesions, intermingled wit
tubercle and fibroid thickening of the inter-alveolar tissue. 1 ie nn
bronchi ’are seen to have thickened walls, and much increase of the pe ;
bronchial tissue. In connection with these are granules of a soft greyish^
yellow character, which are composed of two or more adj. c
filled with proliferated fatty epithelium. Similar but larger

caseous

filled with prohteratea iaLty epitnenum.

deposits {varying in site from a ■ ^ “"motions. and

Surroandingsu^ broncho-pneumonic and peribronchial gntnulations
also noon the walls of the thickened broncbn.es, » . . smaU"
or lymohoid growth, form, no minute excrescences, -true m, ^

Much of this tubercle also shows degenerative changes— particu y

metamorphosis. The inter-alveolar connective tissue is hyperplast

deeply pigmented. . ,

From a European (malel patient, aged 22, a leper, who died in hosp.teb
(See further, “ Medical Post-mortem Records, vol. 1,

The aoex^of\he lung of a patient “who died from abscess of
the liver,” exhibiting an irregularly rounded calcareous cone
tion, the size of a hazelnut, and a few smaller ones aioun

83.

SERIES VII.]

TUBERCULAR PHTHISIS.

225

The mass is situated quite superficially. The superjacent pleura
is thickened, depressed or puckered, and cicatricial-looking, and
the surrounding lung tissue condensed and fibroid in appearance.
The preparation illustrates that condition which, by the older
pathologists, was termed “ obsolescence of tubercle.” (. Presented
by Dr. Beatson of the General Hospital.)

84. The apex of the right lung showing puckering of the pleura, con-

densation and fibroid thickening of the pulmonary tissue, and
the presence of several small cretaceous nodules, surrounded by
a limited deposit of miliary granulations (tubercle). — From a
European male patient, aged 31, who died from chronic dysen-
tery. (“Medical Post-mortem Records,” vol. II, 1878, pp.
G63-64.)

85. Sections from the apices of both lungs of a native male patient,
'aged 24. At the right apex is a small patch of miliary tubercle
undergoing caseation and softening. At the left apex a circum-
scribed patchy of the same kind, but in a state of hardening or
induration from fibroid thickening of its own structure, and of
the surrounding pulmonary tissue— the so-called “obsolescence of
tubercle.” (“Medical Post-mortem Records,” vol. Ill 1879

p. 12.)

86. Apex of the right lung preserved to illustrate the so-called “ obso-
lescence of tubercle.” It exhibits a thickened and puckered
condition of the pleura, one large and several smaller cheesy
nodules beneath it, and condensation, fibroid thickening, and
pigmentation of the surrounding pulmonary tissue.

•87. A section from the apex of the right lung of a native male
aged 31, who died from remittent fever and dysentery. There is'
a puckered, cicatricial condition of the pulmonary pleura,
and, immediately beneath it, a small contracting vomica, about
the size of a hazelnut, having a well-defined lining membrane.
It contained a few drops of thick, puriform fluid, and is sur-
rounded by condensed, fibroid, and pigmented lung-tissue. The
preparation illustrates one method by which small vomica} become
obliterated.

i88. 1 he right lung showing most intense tuberculosis. Small, hard,

grey, and larger, softer, more opaque granulations are seen thickly
infiltrating the superior and middle lobes and the posterior
margin of the lower lobe. The lung tissue is firm, dense, and
much consolidated, except at the immediate apex, where a cavity
the size of a a hen’s egg exists, traversed by obsolete bands of
iibro-vascular tissue, and surrounded by a dense miliary growth.
Although much of the tubercle is incipiently caseous, yet no
large cheesy nodules are to be found in any portion of the luno- •
and the lower half of the inferior lobe is quite spongy and crepi-
tant. The condition of the opposite lung has not been recorded
but the anatomical characters of the right lung seem to warrant
the conclusion that the disease was essentially tubercular and
probably very rapid in its course,— an example, in fact ' of
oru* tubercular phthisis (“galloping consumption”).

226

TUBERCULAR PHTHISIS.

[series VII.

89 A portion of the right lung of a native child, showing diffuse
granular tuberculosis, with much thickening of the visceral
pleura and firm adhesion to the diaphragm. The most remark-
able lesion, however, is a cavity, the size_ of a pigeon s egg, at
the lower extremity of the anterior margin. It has a well-defined
outline, and is said to have “ projected beyond the level of the
organ, at which point thick layers of adhesive matter have been
thrown out to prevent its effusion into the chest. It contains
soft caseous material and shreds of disorganised lung-tissue.
The inner surface is smooth and lined by a “pyogenic mem-
brane ” of considerable thickness. The bronchial glands show
evidences of caseation and pulpy softening. ( Webbs

Paiholoqia Indica," No. 261, p. 138.) , u

90 “ A section from the lower lobe of the right lung of an adult

Mahomedan who died in hospital. It is studded with clusters
of miliary tubercles ” and small rounded excavations (vomicae).

“ The pleura covering it is much thickened hv false membrane.
The apices of the lungs were riddled with large cavities. I le
spleen was soft, diffluent, and also infiltrated with tubercle.
(Ewart.) ( Presented by Professor C. R. Francis.)

91 “Sections of the lungs of a young English lad who died at the

ao-e of 18 from acute phthisis. Latterly he nad hectic eveiy
nmht His extremities became (edematous. He expectorated
large' quantities of muco-purulent fluid. Both at the right and
left upper lobes there were cavernous breathing, guiglmg, and,
lower down, tubular breathing. Dulness on percussion; no

The apice^ of both lungs°are crammed with cheesy tubercular matter,

1 and in varying degrees moderately riddled with small cavities.
Besides, throughout the substance of the lower lobes, there is
much consolidation from tubercular growth, both -ol the cheesy
and miliary form. The preparation is put up to illustiate
nhthisis in a European, purely contracted in Bengal.

Few Months ago the hoy was quite well He caught, as it
appeared to his parents, a common cold. This nevei left him.
It settled on his lungs, and the < specimens are ^ejnemona s
of the whole thing from beginning to end—ot, in tact, a case
of what in England would be regarded as ordinary phthisis,

* running a rapid course. (Ewart.) . ,

There is extensive pneumonic consolidation of both organs, associa
r With diffuse miliary tuberculosis. No caseation nor cavitie
can now be distinguished, except some breaking down of
consolidated lung-tissue at the apices. (J. 1 . P. MeC.)

09 A nortion of the left lung showing a tubercular cavity, the size
92' V l mall orange, at the apex, from which fatal haimoi-rhage
(hemoptysis) occurred. A fine green glass rod has beer ^ passed
into one of the pulmonary vessels which was found 1
nr uleerated upon the inner surtace of the vomica. The lun*
tissue for from one-fourtl, to half an inch around the excavation
is consolidated; partly from pneumomo, pavtlj l'°n
cular changes (i i.e ., inliltration with cascading granulations,.

SERIES VII.]

TUBERCULAR PHTHISIS.

227

There is free communication between the cavity and one of the
larger branches of a primary bronchial tube.

93. The right lung from a case of pulmonary phthisis, showing a
cavity, about the size of a walnut, at the junction of the
superior with the inferior lobes of the organ on its right lateral
aspect. This vomica is occupied by a yellowish-white fibrinous
clot, the size of a pigeon’s egg. There are several smaller
cavities in this lung, with numerous cheesy nodules, and some
patches of recent pulmonary apoplexy. From a native male,
aged 40. During life the patient had several attacks of haemop-
tysis, each very profuse or copious. Over the right apex
there was cavernous breathing and gurgling.

The cavity above described is lined by a thin “pyogenic membrane;”
and when the fibrinous coagulum is removed, the indurated and
obstructed remains of several large blood-vessels can be traced,
ramifying in various directions across its inner surface.

Portions of such, examined microscopically, show condensation and obliteration
of their channels, and plugging with recently effused blood (minute
thrombi). Two or three large-sized bronchules can be traced up to the
cavity, but not actually into it, their terminations appearing compressed
and filled with coagulum Moreover, fragments of soft disintegrating
blood-clot can be distinctly traced backwards into the right bronchus,
'the cavity is surrounded by a rampart of consolidated pneumonic lung,
about a third of an inch in thickness. Several large branches of the right
pulmonary artery can also be traced into close connection with the cavity,
but again, owing to the surrounding consolidation, not directly into its
interior. There seems no doubt, however, that the hemorrhage * proceeded
from one or more considerable sized vessels. No aneurismul condition of
the pulmonary vessels in or near this vomica could be detected.

The rest of the lung exhibits numerous cheesy nodules, small cavities
with dilated bronchi— at the apex in particular; and an abund-
ant infiltration of miliary tubercle. These changes were less
marked in the opposite (left) lung. The fibrinous clot is a
recent one, the result of the last fatal haemorrhage which took
place about four days before the death of the patient, and from
which he never rallied. In the fresh state the clot was found
soft and pulpy at the centre, dark coagulum and fluid blood
being found here, while the periphery alone presented a firmer
decolorised condition.

194. Both lungs exhibiting several circumscribed excavations (vomicm),
with diffuse miliary or granular infiltration of the pulmonary
tissue— lesions characteristic of true tubercular phthisis.— From
a native male, aged about 40, who died in hospital. (See further,

Iq. Medical Post-mortem Records,” vol. II, 1877, pp. 471-72.)

Right lung showing very characteristically the morbid anatomy
ot acute tubercular phthisis. The lung is largo and heavy"-
its superior lobe riddled with cavities, varying in size from a
pea to a nutmeg, and containing thick, yellowish, muco-purulent
secretion. They are surrounded by pulmonary tissue, solidified
either from recent pneumonia or from cheesy changes. Irresru-
, . y »ut thickly distributed around and between these excava-
tions are patches of miliary tubercle, some semi-transparent hard

228

CHRONIC CATARRHAL PHTHISIS.

[series VII.

and recent, the majority yellowish from commencing caseation.
The whole of the middle and lower lobes is free from cavities,
hut very dark and congested (in the fresh state), and thickly
infiltrated with isolated miliary granules, or small patches ot the
same, and, for the most part, apparently, of very recent develop-
ment.— From a native woman, aged about 36, brought to the
hospital in a moribund condition, and who died within twelve
hours of admission. (“ Medical Post-mortem Records, vol. 11.1,

1880, pp. 617-18.) ,•

96 Base of the left lung showing great consolidation or condensation
of structure from infiltration with the caseous products of
catarrhal pneumonia; in parts also excavated. The caseous
masses form nodules varying in size from a pea to a laigo pin $
head, and are soft, friable, and yellowish. The largest excava-
tion is at the immediate base; it is the size ot a hen s egg, is
nartiallv lined by an opaque membrane, and into it are seen
opening several bronchial tubes. Another excavation the size
of half a walnut, also lined by a very complete membrane, is
sPim higher up The interlobular connective tissue is through-
out more or less hypertrophied, and the pulmonary pleura
shows^much inflammatory thickening. There is no evidence
of any true tubercle (grey granulations). (Webb s Patholopa

an lthlfuuim°exh1biting1tlo) large and' several smaller excavations

■ in the upper lobe. One, at the immediate apex, is the size of a

nmcon's «, and lined by a distinct false membrane. 1 he
tissue around it is consolidated and infiltrated with sma
miliary granules. A little below this is a larger vomica into
which a medium-sized bronchial tube is seen to enter. Small
cheesy deposits and tubercular granulations were found scat-
tered irregularly throughout the middle and lower lobes l ie

left lune^ was quite free from disease. In the recent state the

eft lung 1 uja The patient, a “ Mahomedan,

aged°40,” died from hemoptysis. (Webb’s Pathologw Imhca

qq S native, showing most extensive disorganisation

98' Of structure. The pleura is greatly thickened, and firmly

. flip whole oivan. At the apex is a vomica the size ot

Ismail orange with several smaller loculi communicating
directly or indirectly with it. The anterior and superior boundanes
f tlb 1 Kro-c cavity are formed by thickened pleui a only.
lllS LvTfragved appearance. Below this, the rest of th
1 is riddled with smaller excavations, and presents

X much chronic pneumonic eonsolidatmn^ and caseation. ol

try' 'few sotoiil°g'rror °caevities“ml( Webb’s Pat'hologia Indica,

99 K beautiful Specimen of cheesy bronchitis ot pne=m. The
action of lung substance preserved shows extensive
solidation of the pulmonary tissue by caseous mh f.at.o.^ • r
smaller bronchules and an-cclls or alveoli me all hUcd »w

series vii.] CHRONIC CATARRHAL PHTHISIS.

229

opaque-white material. The bronchi are dilated, their walls
thickened, and exhibit lateral and terminal rounded (bulbous)
expansions, — these varying in size from a pea to a pigeon’s egg.
Even the larger ones are clearly demonstrated to be directly con-
tinuous with the expanded bronchi, for they are lined by a
common membrane. Where the soft caseous matter has dis-
solved out, the lung-tissue presents a very strikingly reticulated
or honey-combed appearance. One large excavation, situated
at the lower end of the section, contained the ovoid calcareous
concretion now moored to the same by a thread. The pleura
is thick, opaque, and ragged-looking. The interlobular tissue
incipiently hypertrophied and pigmented. (Webb’s Patholoqia
Indica, No. 376, p. 134.)

100. A preparation exhibiting very characteristically the morbid

anatomy of chronic catarrhal or caseous phthisis. Almost the
whole of the pulmonary tissue is consolidated and of a greyish-
white colour. The bronchi show inspissation and caseation of
their contents, — those towards the periphery being completely
blocked by the same. The pulmonary alveoli and infundibula
are similarly altered, — their proliferated epithelial contents con-
verted into soft cheesy material. Accompanying or associated
with these changes are small excavations at the apex, and
throughout the superior lobe. These communicate directly with
thickened and dilated bronchial tubes, and are evidently consti-
tuted by circumscribed but irregular expansions of the same.
They are all lined by a distinct, soft, opaque-white membrane,
continuous with that of the bronchi. Groups of broncho-
pneumonic granulations surround the peripheral tubules. The
interstitial or interlobular tissue is thickened and fibrous-looking.
Small portions of apparently healthy pulmonary tissue remain in
the lower lobe. Much dark pigmentation of the lung is through-
out evident. ( Presented by Dr. Clark.)

101. A large anfarctuous cavity (vomica) occupying the upper half of
the superior lobe of the left lung, the rest of which is in a state
of pneumonic consolidation. The specimen is a good illustration
of the multiseptate character of many phthisical cavities.

102. A section from the lower lobe of the left lung, preserved to
illustrate the commencing excavation of lung-tissue which
follows upon the caseation of the products of catarrhal
pneumonia. By an extension of the process here exemplified, the
larger caverns or vomicse of pulmonary phthisis are often
constituted, i.e., by the coalescence of minute excavations to
form larger ones.

Under the microscope the air-cells are found broken down; two, three, or more
uniting to form a little cavity, filled with soft cheesy material, and con-
sisting of shreddy, disintegrating epithelium, with granular and molecular
fat. (Much of this material has dropped out in the preparation of the
specimen.) The alveolar dissepiments are found atrophied, and the
alveolar wall and inter-alveolar connective tissue infiltrated with granular
fatty cells, the size of pus corpuscles, and much pigment.

From a native male patient who died from chronic catarrhal pneumonia.

230

CHRONIC CATARRHAL PHTHISIS. [series vii.

103. The whole of the left lung showing much enlargement and con-
solidation, the result of broncho-pneumonic changes. Large
numbers of pigmented granules, the size of swan-shot, infiltrate
the pulmonary tissue. The bronchial tubes and their branches
are throughout dilated, and exhibit abnormal vascularity and
thickening of their lining membrane. No excavations or vomicae
were found in either lung, and no true miliary tubercle. All
organs of the body were free from the latter.

The microscopical examination of sections taken from this lun^ revealed very
characteristically the morbid anatomy of broncho-pneumonia with peri-
bronchitis. The granules above referred to are hard, opaque, and. pig-
mented; many of them show on careful examination a very minute
opening or aperture at the centre, evidently the cross-section of a terminal
bronchule ; and, after brushing out the sections, it is seen that the pulmo-
nary alveoli immediately surrounding such terminal bronchules are filled
with inflammatory products, i.e., proliferated epithelium, granule cells and
masses, free granular fat, withered blood cells, pigment, &c. The bronchule-
walls are thickened, the interior (channel) occupied by fatty epithelial
debris. There is‘very little inter-alveolar growth ; the changes are almost
entirely intra-alveolar. In parts, however, some inter-alveolar proliferation
can be recognised, and consists of small round lymphoid cells, indis-
tinguishable from the adenoid structure of true tubercle. Yet the main
or principal disease is broncho-pneumonic, not tubercular.

104. Both lungs exhibiting well-marked characters of chronic catarrhal
pneumonia (non-tubercular phthisis). The superior and middle
lobes of the right lung and the whole of the left are filled with
large cheesy masses and cavities of various sizes. The inter-
lobular connective tissue is greatly thickened. The bronchial
tubes are throughout dilated ; their walls thickened ; their lining
membrane soft, swollen, and of dark-purple colour (in the fresh
state). They, as well as the lung excavations, were occupied by
thick muco-pus. The latter (cavities) are largest in the left
lung. At the apex there is one, the size of an orange, irregular in
outline, and its roof formed by thickened pleura only. About
an inch below this is another vomica, the size of a hen’s egg ;
and in the lower lobe a third, as large as a walnut. All these
communicate freely with large-sized bronchules, and are lined by
a kind of “ pyogenic ” membrane. Smaller cavities of the same
character are found in both organs. In neither can any miliary
tubercle be discovered (except microscopically). — From a native
male, aged 35. (“ Medical Post-mortem Records,” vol. II, 1877,
pp. 317-48.)

105. Right lung showing very typically the morbid anatomy ot
catarrhal (non-tubercular) phthisis. This lung has two lobes
only. Both these are seen to be riddled with various sized,
irregular-outlined excavations. They communicate freely with
larger and smaller bronchules, and contained thick muco-purulent
fluid. All are lined by a distinct opaque-white membrane, and
around each, for a variable distance (two or three lines to hall
an inch), the pulmonary tissue is consolidated, pneumonic, reddish-
brown in colour, with here and there interspersed cheesy nodules,
and broncho-pneumonic granulations. No true grey tubercle.
— From a native male, aged 1G, who died in hospital.

series vii.] CHRONIC CATARRHAL PHTHISIS.

231

106.

107.

108.

109.

Non-tubercular phthisis or chronic catarrhal pneumonia of the
left lung. The pulmonary tissue is consolidated, partly from
recent lobular pneumonia, partly from cheesy transformation of
the same. It is also riddled with small cavities, irregular outlined,
and with thin intervening septa of disorganising lung substance.
These cavities vary in size from a hen’s egg to a pea, and contain
thick yellowish purulent secretion. There is hardly any healthy
lung tissue remaining, yet no miliary granulations are visible to
the naked eye. (“ Medical Post-mortem Records,” vol. II, 1877,
pp. 483-84.)

A longitudinal section from the central portion of the right
lung, illustrating very beautifully the characters of chronic
caseous pneumonia (non -tubercular phthisis). The lung sub-
stance is seen to be much consolidated and riddled with cavities,
varying in size from a walnut to a pea. They contain thick
reddish-yellow muco-purulent fluid. There are also numerous
cheesy deposits. The bronchial tubes are throughout dilated, and
communicate both with the cavities and caseous nodules. The
inter-lobular connective tissue in parts of the section is seen to
be hypertrophied. The whole of the right lung was affected ;
the left oidv partially. The former weighed 50 ounces. — From a
native male (Hindu), aged 44. (“ Medical Post-mortem Records,”
vol. HI, lb80, pp. 447-48.)

The left lung of a native male patient, aged 25, who died from
cluomc catarrhal or non-tubercular phthisis. The upper half
of the superior lobe is riddled with small cavities, varying in
size from a pea to a sparrow’s egg, and communicating
(generally) with small-sized bronchules. They are surrounded by
pulmonary tissue solidified from recent and progressive pneumonic
changes, or by small cheesy infarctions or broncho-pneumonic
granulations. The rest of the superior and the whole of the
lower lobe have a coarsely-granular appearance at the surface
and on section. This is due to the presence of innumerable
broncho-pneumonic granulations, some as large as a split-pea,
the majority the size of millet-seed. No grey granulations
(ti ne tubercle) are to be detected. The right lung presented
similar but more advanced changes, and was equally free from
miliary tubercle. (See further, “ Medical Post-mortem Records,”
vol. HI, 1880, pp. 549-50.)

The lungs of a native female child, aged 12, who died in
hospital. Roth organs are larger and heavier than normal ;
their surfaces roughened, granular, dotted over with little
opaque-white bodies. The latter are also seen diffusely and
thickly infiltrating the deeper pulmonary parenchyma. They
vary in size from a large pin’s head to a sago or tapioca-grain
are distinctly cheesy, rounded, and circumscribed. A great
many present, at the centre, a minute tubular or hollow space
evidently the cross-section of a divided bronchule. The granules
<ire, in fact, peri-bronchial in character; a few broncho-
pneumonic, none tubercular. The great majority are isolated
or separate, quite sharply defined. They are so abundantly

232

FIBROID PHTHISIS.

[series VII.

distributed that scarcely any normal lung-tissue remains ; and that
which does, was, in the fresh state, deeply congested and of dark-
purple colour. The bronchial tubes were filled with thick,
reddish, sticky secretion (mucus) ; their lining membrane soft
and vascular. The bronchial glands were all enlarged and
pigmented,— a few cheesy.

Microscopic examination confirms the naked eye appearances of the granules
above described. The minute bronchules are found filled with degenerate
fatty epithelium or opaque cheesy material. Their walls much thickened
and nucleated, the surrounding pulmonary alveoli in a state of catarrh—
the walls thickened, the epithelium in a state of proliferation. No
tubercular growth can be discovered.

(“ Medical Post-mortem Records,” vol. Ill, 1880, pp. 599-600.)

110. The upper and a portion of the middle lobe of the right lung.
The former has been hollowed out into a cavity the size of a
large orange, the walls of which are principally formed of very
firm, thickened, and condensed pleura. The interior is irregularly
multilocular, exhibits old fibroid strands of obsolete vessels, &c.,
and is seen to 'communicate freely with several large-sized bron-
chial tubes. The middle lobe has, on one side, a series of

. similar excavations, in size varying from a walnut to a
hazel-nut ; on the other, the pulmonary tissue is condensed and
firm, densely infiltrated with minute pale-grey granulations,
and shows considerable thickening of the interlobular connective
tissue (chronic fibroid phthisis) . (. Presented by Dr. C. Palmer

of Jessore.)

111. Chronic (fibroid) phthisis. An example of chronic phthisical
changes in the lungs. Both organs are about equally affected.
The pleura is universally adherent and greatly thickened. The
lung substance is seen to be throughout infiltrated with small
caseous nodules (from a small pea to a hazel-nut in size), follow-
ing closely the ramifications of the bronchi. The hitter are
everywhere large and dilated ; their walls thickened, and more
or less opaque. The interlobular connective tissue is hypertro-
phied, forming bro’ad, white, fibrous-looking bands, traversing the
lung-tissue in all directions. At the apices and anterior margins
small cavities are observed, not larger than half a walnut, with
semi-solid cheesy contents. {Presented by Professor Allan Webb.)

112. Chronic fibroid phthisis. The whole of the superior lobe of the
left lung has been converted into a cavity the size of the closed
fist, the walls of which are lined by a distinct velvety,
soft, opaque, pseudo-membrane, beneath which a thin shred of
lung-tissue can be discerned, and this, in turn, is invested by
greatly thickened pleura. The latter is, in parts, quite one-eighth
of an inch in thickness. The lower lobe is firm, much con-
tracted and condensed. At its upper part is hollowed out into
a few small cavities, all lined by smooth false membrane. At
its lower part it is carnified-looking, shows much increase of the
interlobular tissue, the exaggerated, broad white bands of which
are very distinct, and, towards the periphery, become continuous
with the thickened tissue of the pleura. The whole lung

SERIES VII. J

SYPHILITIC PHTHISIS.

233

113.

114.

115.

is greatly reduced in size. ( Presented by Professor Edward
Goodeve.)

The lower, and a portion of the middle lobe of the right lung
illustrating the characters of fibroid phthisis. The pulmonary
tissue is seen to be much condensed. It is traversed by broad
opaque-white bands of fibrous tissue, the result of an hyperplasia
oi the inter-alveolar and interlobular connective tissue. These
bands terminate at the periphery of the organ by becoming
continuous with a highly thickened and leathery pleura, which
invests and, as it were, compresses the lung substance. There
is also a good deal of general dark pigmentation of the pul-
monary tissue, and a section made through three enlarged
bronchial glands at the root of this lung shows a similar coal-
black condition of their structure. Both lobes are riddled with
small, irregular-outlined cavities or vomicae, several of them
communicating directly with bronchules of the third or fourth
series (as regards size). Almost the whole ol the superior lobe
was involved in a large anfarctuous cavity, with thick, fibroid walls.
Lastly, there is a diffuse and abundant distribution of miliary
tubercle, chiefly in an incipiently caseous condition, but also, fresh
giey hard granules. The left lung exhibited similar morbid
changes, but not to so advanced a degree. The subject was a
European seaman (a Swede), aged 26. (See further, “ Medical
Post-mortem Records,” vol. I, 1874, pp. 323-24.)

The upper half of the left lung, with its corresponding bronchus
and branches. The lung-tissue is seen diffusely infiltrated
with miliary granulations, mostly in small circumscribed
patches. With this also are small depdts of softening and
cheesy infarction, and a few small circumscribed cavities. The
largest cavity is situated about an inch below the apex, and is
the size ol a walnut. The apex itself is almost solid, shows three
or tour small pea-like excavations surrounded by thickened
condensed, and fibroid-looking tissue, in which only a few
granulations are to be seen. The same kind of fibroid thicken-
ing °i the inter-alveolar and interlobular connective tissue
ot the lung is a marked feature in the morbid anatomy of
the rest ol this portion of the lung, so that, in spite of con-
siderable softening and destruction of the proper structure, the
lung-substance is remarkably firm and rigid. Many also of the
so i ary granules and small miliary patches have this same pecu-
liarity, ze ., an abnormal degree of resistance and dryness. The
preparation illustrates a variety of fibroid phthisis, which may
probably be regarded as syphilitic , since the patient, a West
ndian, had a marked syphilitic history, and presented nodes on

t^k^J.fresentcih Dr- A' Vans Best’ Presidency

Sections from the left lung showing cheesy consolidation, with
broncho-pneumonic changes and fibroid thickening of the inter

nfaUrcHoCn°^eCtl iT Proba% syphilitic. The cheesv

infarctions are all of small size— none much larger than a pea—
and are particularly dense and firm.

2:u

PULMONARY HAEMORRHAGE.

[series VII.

Microscopic sections show (1) a small nuclear growth (syphilitic), especially abun-
dant around the bronchi, both large and small. This peri-bronchial growth
passes outwards into the alveolar walls, thickening them, and leading to (2)
collapse, distortion, irregular dilatation (in some parts), or complete obliter-
ation of the air-cells ; (3) the contents of such as remain consist of degen-
erate epithelium and fatty granular matter, just as is met with in
lobular pneumonia ; (4) in certain situations the small-celled peri-

bronchial growth exhibits a tendency to nodulation, the central portions of
such nodules being invariably more opaque than the peripheral; (5) the
smaller bronchi generally are found obstructed, or more or less filled with
degenerate (fatty) epithelial products; (6) lastly, there is much dark
amorphous pigmentation of the lung, and this, too, is especiallj marked in
the neighbourhood of the bronchi, often obscuring, in this situation, the
small-celled growth above described.

From a native male, aged 35, who had a hard chancre, followed
by secondary symptoms, about six months prior to death, and in
whom a cough with other evidences of pulmonary disease first
manifested themselves during the appearance of a specific skin
eruption. ($ee further, “ Medical Post-movlem Recoids,
vol. Ill, 1879, pp. 325-20.)

116- “ Apoplexy of the lung, particularly well shown in the uppermost

section, in which there is an extravasation as large as a walnut.
It is now of a chocolate colour, contrasting plainly with the sur-
rounding grey pulmonary structure. It is partially pitted in
consequence of the coagulum having crumbled out of the cut
cells during maceration.” (Ewart.)

117. Both lungs of a native boy, aged 11, who died from cancrum oris
and sub-acute dysentery. These organs exhibit very abundant
superficial and interstitial purpuric blood extravasations or
ecehymoses, and illustrate a common morbid change observed
in cases of spansemia, the blood readily separating from the
weakened blood-vessels, assisted by a feeble and slow circulation.

118. A preparation showing the right lung, over the surface of which
are scattered numerous dark-brown patches varying in size from
a pea to a walnut. The larger patches are situated chiefly at
the base. They are all haemorrhagic infarctions, are distinctly
circumscribed, and surrounded by hyperaemic zones. On inci-
sion, each infarct presents a smooth surface of a dark-red
colour ; some firm and solid throughout, others in a state of
incipient softening. From a native male patient who died in
hospital from pyaemia.

119. The superior lobe of the right lung showing a cavity, the size
of a walnut, which was found filled with semi-solid curdy material,
consisting chiefly of altered blood. The patient, a West Indian
(Neo-ro), aged 40, had several attacks of profuse haemoptysis
shortly before death. Both lungs exhibited all the characters of
catarrhal phthisis.

On microscopic examination of the walla of the little cavity the vessels in and
around it exhibit, in parts, some thickening, due to a small-celled pcriv.ts
nuclear growth (tubercle) ; in others, much thinning, atrophy, alw«J
complete disappearance of the transverse markings (muscular coat), ana
fatty degeneration. No pouching or aneurisms! dilatation of the walls
these vessels is observed.

SEBIES VII.]

CARNIFICATION OF THE LUNG.

235

120. “ (Edema of the lung. In this preparation, from the lung of
a Hindu, the cellular structure that unites the lobules is distended
with water or serum ; perfectly transparent, like white lines,
dividing the lobuli. The air cells are also distended with fluid,
leaving the minute vessels distinctly seen, ramifying upon their
parieties. The lung sinks in the spirit, and is wholly unfit for
respiration, every cell where air should enter being occupied by
fluid.” (Allan Webb’s Patliologia Indica , No. 243, p. 138.)

121. Atelectasis pulmonum, — the imperfectly expanded lungs of a
seven-months’ child.

122.

123.

pleura, causing
atrophy of the
(Allan Webb’s

125.

The child was born before medical aid arrived, and was thought by the
attendants to be dead. It was found cast aside and lying
underneath the placenta. On removing this, the child was seen
to attempt respiration. When placed in a current of air it
began to breathe. It died from asthmnia and apnoea seven or
eight hours afterwards. The blood was remarkably dark, and
it was reported to have brought up some by the mouth prior
to death.” (Ewart.)

Acquired atelectasis or collapse of the lung, with complementary
emphysema of the adjacent pulmonary tissue. The specimen
consists of a small portion of the left lung showing a circum-
scribed rounded patch, quite collapsed, firm, and destitute of air ;
succeeding this, and intervening between it and the healthy luno-.
tissue, is a large emphysematous bulla or bleb.

“ Granular tubercular depositions upon the
effusion (nine pints), compression of the lung,
heart. — From a Hindu woman, aged about 45°”

Pathologia Indica , No. 1018, p. 137.)
tubercular granulations can now be discovered affecting the pulmo-
nary pleura, but the costal layer of this membrane is much
thickened, and shows small hard granules, varying in size from a
pins head to a swan-shot, disseminated throughout the sub-
serous connective tissue. Both costal and visceral layers of the
pleura are thickened, softened, and covered with shreds and films
of recent lymph. The whole of the lung (right) is great] v
compressed, and completely carnified.

Carnification of the lung, from a case of empyema. The com-
pressed and atrophied condition of the organ is well illustrated in
ie specimen, and also its almost solid appearance on section.

tlT'fr -0f P,a,1ly organised lymph invests the entire
sui lace ol the visceral pleura.

Complete carnification of the left lung, the result of hydro-
thorax. Ihe organ is seen to be much reduced in size. It is
irm and semi-solid on section, almost absolutely destitute of air.
All these changes are due to hydrostatic pressure upon the soft
yielding and spongy pulmonary tissue. — From a native female
who died in hospital. alc

ovm- it”n (EwTrtf ^ ^ ^ thickCned pulmonary PW

‘‘Specimens of emphysematous lung from a Hindu. The various
sections illustrate the uniform dilatation of the pulmonary

1124.

126.

127.

23(3

PULMONARY EMPHYSEMA.

[series vir.

cells, particularly near the margin of the organ. Some of
the emphysematous bladders are, however, as large as peas.
The contrast between the lung altered by emphysema and the
healthy parenchyma is admirably shown. In the former the
parenchyma is pale and distinctly spongoid ; in the latter it is
greyish, intermingled with dark spots, and presenting an
innumerable number of almost normal-sized pulmonary cells.
Moreover, the bronchial tubes in the emphysematous portion
are greatly dilated, remarkably so when compared with the tubes
leading to the healthy pulmonary tissue.” (Ewart.) ( Presented by
Professor Allan Webb.)

128. Extreme vesicular emphysema of the left lung of a native
patient. The morbid condition is most marked at the apex and
along the anterior margin. In the former situation the pulmo-
nary tissue is raised into a series of bull®, which vary in size
from a pea to a walnut. At about the centre of the anterior
margin is a very large multilocular bulla, with exceedingly thin,
delicate, and transparent walls. At the inferior termination of
this border is another similar development somewhat smaller
in size. Small limited patches of apparently pneumonic consolid-
ation are observed in the neighbourhood of the two latter.
The lung-tissue is throughout very darkly pigmented, and the
bronchial tubes are dilated.

129 Complementary or supplementary vesicular emphysema. The
preparation exhibits a section from the inferior lobe of the
ricrht lung, including its anterior margin, with a large emphy-
sematous bleb surrounded by a depressed dark ring ol collapsed
lung-substance. The rest of this lobe is in a state ol ‘ red
hepatization.” — From a European male, aged 32.

130 Emphysematous anterior margins of the lungs. The pulmo-

narv tissue is seen raised into large semi-transparent bull® and
smaller pea-like vesicles along the whole length of these excised
margins. It is also throughout very darkly pigmented.— F rom
a native male, aged 60, who had long suffered from chrome
bronchitis, and died from remittent fever.

131 The anterior margins of both lungs from a case of cholera a
native male, aged 30— showing extensive vesicular emphysema,
associated, in parts also, with interstitial or interlobular emphy-
sema. The emphysematous portions are distended so as to form
distinct bladder-like prominences, which are arranged in a mon-
iliform manner along the free edge or margin of each lung.

132. A portion of lung showing extensive dark pigmentation. No

123 Senile melanosis of the lungs. Both organs are seen to be
uniformly and very darkly pigmented. The colouring is most
intense at the surface, just beneath the visceral pleura.

From an East Indian (J. D’U. ), aged 49, who died from fevei

with h®matemesis.” ...

134. Both lungs preserved to illustrate the excessively pigmenteci
condition of these organs so commonly found associated with e
chronic bronchitis and emphysema of old age. Taken iroin a

SEB1ES VII.]

CANCER OF THE LUNG.

237

136.

native female, aged 55, who died from acute dysentery. The
pigment matter, which is of coal-black colour, is especially thickly
distributed at the surface of the lungs, just beneath the pulmo-
nary pleura ; and, in the interior, occupies chiefly the inter-alveolar
and intei lobular connective tissue. It is amorphous and gran-
ular in character.

135. Both lungs of a native adult, very profuselv infiltrated with
nodules of medullary cancer. They are in great abundance, both
in the parenchyma of the lungs and also on their surfaces, — in the
latter situation just beneath the pulmonary pleura. They vary
in size from a pigeon’s egg to a pea. The majority are flattened
and a little depressed on their free surfaces. They are soft and
brain-like in appearance and consistency, and, under the micro-
scope, present all the characters of rapidly proliferating medullary
or enkephaloid cancer, the cells and stroma being both well
marked— the former polymorphous, nucleated, and exceedingly
numerous ; free nuclei and fat granules also abound. The °r0wth
affects both the pleura and pulmonary tissue proper.

Enkephaloid carcinoma of the lungs. From a native male patient,
aged 30, who died from haemorrhage and exhaustion attending
the growth of a medullary cancer, the size of a cocoanut, in the
nght diac fossa. Both lungs are seen infiltrated with soft, pink-
ish-white nodules, varying in size from a split-pea to a hazel-
nut, distributed freely over the surfaces, and also in the
c eepei pulmonary parenchyma. The microscopic examination
of these secondary growths, as well as of the primary or original
tumour showed cancerous (enkephaloid) structure. ( Presented
by Professer J. A. Purefoy Colies, m.d., &c.)

Enkephaloid carcinoma of the lungs. A secondary manifest-
ation or deposit in a case of primary cancer of the testicle.

uropean male, aged 43. Both lungs are infiltrated,
especially near their surfaces, with cancerous nodules varying
m size from a duck’s egg to a pea. They had, in the fresh state,
pa e-pink colour and a brain-like appearance and consistency.

On cro8cop^c exa mi na t ion ^ the nir cells are found blocked with fatty disintegrat-

widenh^o It Ilf m °bu ar Pneuraoni»> and co-existing with this is a

stroma %n f I1’ nil1' jter/'a Vt° i,r connective tissue into a soft cancerous
cells The farf y 6 ^ (m l’rushe(1 oufc sections) with large epithelial
intra-alveolar ^-fiari® 11,‘rgeJ by comParis°n. and better defined than the
elements si P't'1®lla| products, and although the majority of the cell

disintec rat 't W ,iy 1"hltrntlon> they are not so much broken up or
smtegrated as the proliferated elements of the air spaces.

J13R UrRhe-’ “Surgical Post-™ortem Records,” vol. I, 1875, pp. 237-38.)

growths n ” Vff te nsi ve^ infiltrated with soft, cancerous, nodular
henV arenof aI1r^es; the largest about that of a

at tL T ieSt ,°f a Pea- The>T are situated mostly

have raised aC0S f 1^° UngS’ T dlstinc% circumscribe^
consisteTcv ? f and sligh% flattened surfaces

dcveronmentasn ° and brain-like. They are seconda^

femur P a k fn a,case °f . Pnmary enkephaloid cancer of the
native lad, aged 15, whose thigh was amputated at

137.

238

DISEASES OF THE PLEURA.

[series VII.

139.

140.

141.

142.

143.

This i

the hip-joint. Similar growths were found in the anterior
mediastinum also, and infiltrating the diaphragm, pleura, lumbar
o-lands, &c. (“Surgical Post-mortem Records,” vol. I, 1877,

pp. 897-98 ) j

The anterior margin, of the right lung occupied by a secondary

sarcomatous growth, about the size ot a hen s egg. It ap-
peared to have developed by direct extension from a large
fungating tumour of the right mamma, a recurrent lound-celled
sarcoma. The morbid growth seems to involve chiefly, the
inter-alveolar tissue, the alveoli being blocked by fatty epithe-
lium and granular matter. The structure is distinctly sarcoma-
tous, consisting of round and oval cells, with large single or double
nuclei imbedded in a kind of granular protoplasm, i.e. , pos-
sessing no formed intercellular substance or stroma. Iheie
was a 'similar nodular infiltration of the liver.— From a native

female, aged 27. . . ~ ,

Tuberculosis of the lungs, liver, and spleen of an Orang-utan
(Simia Satyrus). “ In the lungs the deposit is of a yellowish
colour, contrasting remarkably in this respect with the daik-
brown appearance of the pulmonary structure. The suiface
and section arc consequently mottled. The scrofulous deposits
vary from the size of a millet seed to that of a small pea
The spleen and liver also contain tubercular mateiial
similar physical characteristics.” (Ewart.)

“ A very beautiful preparation showing . the
inflammation of the pleura and pericardium,
is united to the pericardium by layers of coagulable lymph
of great thickness, shreds of which are seen covering
the pulmonary pleura. On section the lung is observe
to be fleshy in consistence— a condition produced by the com-
pression to which it has been subjected by the effused fluid.
This is particularly noticed at the base, where the whole
structure presents a yellowish appearance, contrasting remark-
ably with the grey pulmonary tissue above it. The visceral
pericardium is roughened by the deposition of recent lymph.

Acute fibrinous pleuritis. This preparation is particularly
valuable as illustrative of an early stage in the so-called
“ organisation ” of a “ false membrane,” the result of recent
diffuse pleuritis, and which invests the whole of the lung (right).
The permeation in every direction of this delicate structure by
minute ramifying blood-vessels is especially well seen.— from a

“Abundant deposition of lymph upon the pulmonary pleura
and diaphragm, forming a fringe as thick as the finger up
the free edge of the lung, and coating the surface in a less
degree above, caused by an abscess seen near the apex, bursti . g
into the chest.” (Allan Webb’s Pathologia Inchca, No. 8..,

s^a very good illustration of one of the most frequent causes
of diffuse pleuritis, viz., the rupture of a pulmonaiy i<omi

having

effects of acute
The left lung

SERIES VII.]

PLEURITIS.

230

144.

14 5.

146.

147.

148.

149.

The specimen exhibits a cavity, the size of a small orange,
at the apex of the lung (left), which, at the situation
indicated by a glass rod, has burst into the pleura and
excited the very extensive inflammation and consequent thickening
of this membrane, which the preparation displays. A section
through the lung shows much fibroid thickening and pigmen-
tation of the pulmonary tissue, several smaller excavations,
a few cheesy nodules, and much condensation of the lower
lobe from pressure (carnification).

“ Thickened portions of pleura after pleuritis. There was con-
siderable effusion and detached masses of lymph.” (Colles.)
This is a portion of the costal or parietal pleura. It is tough and
leathery in consistency, and its inner surface presents a highly-
roughened and granular appearance from commencing organi-
sation of the effused lymph.

A portion of the pulmonary pleura. From a Chinaman, aged 50,
who died from chronic pleuritis and tuberculosis; The mem-
brane is seen to be three to four lines in thickness, opaque, firm,
and leathery in consistency. In the fresh state there was some
interstitial mucoid infiltration of its structure.

Portions of greatly thickened pleura, from a case of chronic
pleuritis with effusion. A native male, aged 26, who died in
hospital.

Portions of a rib and of the left lung showing old inflammatory
adhesions between the costal and pulmonic pleura, as also between
the pulmonic and mediastinal, and pulmonic and diaphragmatic
pleuia, and some bands between the contiguous surfaces of the
visceral pleura which invested the two lobes of this luno-. (Pre-
sented by Assistant Surgeon Chunder Mohun Ghose.)

Pyo- thorax. A preparation showing the expansion of the parie-
ties of the thorax and displacement of the heart consequent upon
a purulent effusion into the left pleural cavity. The intercostal
spaces are wide and expanded. The heart lies in front of and
to the right of the spinal column (median line). Both surfaces
of the pleura are thickly coated with opaque, partially organised
lymph, shreds of which, attached by one end to the lung, float
in the pleural cavity. The lung is greatly compressed and
flattened, pushed backwards against the spine, and on section
is seen to be completely carnified. ( Webb’s Patlioloqia Indica,
I\o. 16^2, p. 54.) (Presented by Professor Jackson.)

A preparation illustrating the morbid anatomy of empyema (left).

Probably a vomica had burst into the left pleural cavity A
collapsed cavity is seen at the top of the left lung, and a little
lower down the sloughing margin of an opening communicating
with another.” The whole of the superior lobe is infiltrated
with small caseous nodules and patches of softening. The lower
lobe is compressed and carnified. The right lung shows thicken-
ing of the visceral pleura, and the presence of a pseudo
membrane over the greater part of both lobes. The anterior
*^argms are emphysematous. (Webb’s Patlioloqia Indica
No* 1G47> P- 36.) ( Presented by Dr. Bond, of Burdwan.)

240

EMPYEMA.

[SEBIES VII.

150. A very tine preparation illustrating the pathological changes
which characterise chronic empyema. The left lung is seen
to be pressed backwards against the spine, and much condensed.
Both parietal and visceral layers of the pleura are greatly
thickened, the former especially so, being exceedingly tough,
leathery, and fibrous over the ribs, and in parts quite rigid from
calcareous deposit (infiltration). This condition is most marked
along the spinal attachments of the lower ribs : a thick plate
of thickened and calcified pleura is seen thus extending
between the ninth and tenth ribs. Similar but less rigid and
firm dissepiments will be observed passing between the
thickened opposed layers of the pleura at the level of the
third and fifth ribs, so that this cavity seems to have been
subdivided into three separate and distinct loculi. ( Presented by
I)r. Chuckerbutty.)

151. “ The left pleural sac with the corresponding lung. From a
patient (M. Faucett), aged 29 years, who died of chronic
empyema. The pleural sac was filled with 113 ounces of
greenish-yellow fluid, with floating flakes of lymph. A thick
organised false membrane bound down the left lung firmly to the
spinal column.” This lung is now seen, greatly reduced in size,
compressed, and carnified.

152. Tubercular infiltration of the left lung, with an encysted
empyema. From a native male, aged 41, who died of acute
phthisis. The superior and inferior lobes are both freely infil-
trated with hard, grey, miliary granulations. The pleura is
throughout thickened, and unites the lung to the chest-wall and
diaphragm. At the inner and back part of the pleural cavity,
near the junction of the superior and inferior lobes, an encysted
cavity between the two layers of thickened pleura may be observed.
It contained about six ounces of opaque purulent fluid, with
small masses of coagulated and partially organised lymph. No
direct communication between the lung and this cavity could
be discovered. (See further, “ Medical B ost -mortem Records,’
vol. I, 1873, p. 94.)

153. “ Extraordinary lenticular vegetations projecting from the costal
pleura like small buttons. Some of these are globular, others
more or less elongated. They arise by a broad base, and they
are covered by a smooth membrane continuous with the pleura,
which is greatly thickened. These growths vary in size from a
millet-seed (or small point) to that of a kidney-bean. — From
a native of Bombay, who died from dysentery.” (Ewart )

Examined microscopically, these growths are found to consist of very dense
and firm white fibrous tissue, a considerable amount of granular fat being
also distributed along the course of the fibres, and aggregated into sma
spindle-shaped masses or deposits, apparently representing a similar condi-
tion (fatty infiltration) of the nuclei. They appear to have originate in
the subserous cellular or connective tissue, and constitute, in fact, arge
permanent granulations of the same, completely organised into fibrous tissue.
Small outgrowths of this kind are not uncommon in cases of c ironic
pleurisy, when the inflammatory process has spread to the deeper stia a o
the serous membrane. The preparation therefore probably exhibits mere y

series vii.] CALCIFICATION, Ac., OF THE PLEURA.

241

an exaggerated condition of this kind, and seems also comparable to the
“melon-seed” or “filbert-shaped” growths so frequently formed in
chronically inflamed synovial membranes, e.q., in the knee-joint. —
J.F. P. McC. J

( Presented by Dr. Oxley, of Singapore.)

154. A section from the left lung, which, as well as the right, con-
tained numbers of small calcareous concretions— apparently obso-
lete tubercle — in the upper lobes. No recent grey granulations
were found. In the preparations two of these concretions are
exposed. They occupy the pleura and immediately subjacent
lung-tissue. Each is about the size of a pea. The patient,
a native male, aged 30, died from albuminuria, with amyloid
degeneration of the kidneys, spleen, and liver.

155. Pigmentary growths (melanomata) from the pleura of a horse.
This membrane is greatly thickened, and bears on its surface
groups or bunches of very jet-black, villous or papilliform
growths. These are attached to the inner surface of the pleura,
and in parts involve the sub-pleural tissue, but do not extend into
the proper lung-substance. The majority form tufts composed
of dark, rounded or nodular bodies, supporting secondary and
tertiary developments of similar structure. A few are solitary,
pendulous or polypoid. On section, the smaller growths have
a uniform, homogeneous, smooth, intense black colour ; but, in
the. larger ones, fine whitish fibrous-looking streaks are present,
giving a variegated appearance to the cut surface.

Microscopically the structure of these growths is almost entirely pigmentary the
pigment being deposited in a granular form, aggregated into smaller and
larger points. Between these, a few brown-stained small round cells are
observed, intermingled with a delicate fibrillary network. This cellular
structure, where still transparent,, closely resembles adenoid or lymphoid
growth ; and, in fact, the deposition of the pigment matter appears to have
taken place principally in the sub-pleural lymphoid tissue; it is truly
lymphoid, not carcinomatous. y

Very extensive and remarkable calcification of the pleura.— From
a prisoner in the Presidency Jail. No history preserved.

Left lung completely carnified and compressed by a greatlv
thickened pleura. On the outer aspect of the superior lobe, two

inches below the apex, a circumscribed patch of lymph is seen,

ie size ol a 4-anna piece, and, at its centre, a minute punc-
ture or perforation which communicates with the luno-, and
one of the smaller branches of the superior bifurcation^ the
elt bronchus, The left side of the thorax was bulged out ; the
physical signs ol hydro-pneumo-thorax were distinct during life
and 56 ounces of pale-greenish serum were found in this cavity
alter death. There are a few small, scattered patches of miliary-
tubercle in both lobes of this lung.— From a native male patient
aged 20. (See further, “Medical Post-mortem Records,” vol i’
lo74, pp. 465-66.) ’

156.

157.

242

INDEX.

[series VIII.

Series VIII.

INJURIES AND DISEASES OF THE BRAIN
AND SPINAL CORD WITH THEIR MEM-
BRANES AND BLOOD-VESSELS;

ALSO OF THE NERVES.

INDEX TO THE SERIES.

A.— THE BRAIN.

Effects of external force (laceration, extravasation of blood, &c.),

1,2.

2. — Haemorrhage and its results (not from external force) :

(a) Into the cerebral substance or convolutions, 3, 4, 5, G, 7, 8, 9,

1°.

(b) Into the corpus striatum, 11, 12 13, 14, 15.

(d) „ ,, pons Varolii, 17.

3. — Softening, 12, 13, 17, 18, 19, 20.

4. — Abscess, 21, 22, 23, 24, 25, 26.

5. — Induration (sclerosis), 27.

6. — Atrophy, 28.

7. — Pigmentation (malarial), 29, 30, 31, 32, 33, 34.

8. — Morbid growths*—

(a) Glioma, 35, 36.

( b ) Gumma, 37, 38, 39, 40, 41.

(d) Carcinoma, 44, 45.

(e) Enkephalocele or meningocele, 46.

P.— CEREBRAL MEMBRANES, and the cavities or lining of the

VENTRICLES.

1, Effects of external force—

(a) Laceration, 47 ; 22, Series I.

(b) Extravasation of blood —

a. External to the dura mater, 2.

b. In the arechnoid cavity, 48.

2. — Inflammation (congestion, thickening and opacity, suppuration, &e.),

49, 50, 51, 52, 53, 54, 55, 56.

* See also series XVII.

SERIES VIII.]

INDEX.

243

3 —Calcareous infiltration, 57.

4. — Morbid growths* —

(a) Tubercle, 58, 59, 60.

(b) Glioma, 61, 62, 63.

(e) Gummatous (syphilitic), 64, 65.

(d) Psammoma, 66.

(e) Osteophytes, 67.

G— BLOOD- VESSELS OF THE BEAIN AND ITS MEMBRANES,

including the choroid plexuses.

1. — Effects of external injury, 47.

2. — Thrombosis and Embolism, 68, 69, 70, 71, 72, 73, 74, 75,76, 77, 78,

79.

3. — Aneurism, 72, 80, 81.

4. — Atheroma, 68, 71, 82, 83, 84, 85, 86, 87.

5. — Growths connected with the choroid plexuses, 71, 88, 89, 90.

6. — Preparations from the lower animals, 91, 92.

D.— SPINAL COED.

1. — Effects of External Injury —

(a) Laceration, 93, 94, 95, 96, 97.

(b) Hemorrhage, 98.

2. — Softening (not from external injury), 99, 100, 101.

3. — Congestion and Haemorrhage, 102.

E.- SPINAL MEMBEANES.

1. — Effects of External Injury. 93, 97.

2. — Inflammation (Meningitis), 103, 104.

F.— CRANIAL AND SPINAL NEEVES.

1. — Effects of irritation in amputation-stump, 105.

2. Inflammation of sheath, 106.

3. — Enlargement (neuroma, &c.), 107, 108, 109, 110, f lll.f

Tumour (fibroma), 112.

* See also series XVII.
t lu Leprosy.

244

DISEASES OF THE BRAIN.

[series VIII.

1. “ Specimen showing great and extensive laceration of the right

middle lobe of the brain.” (Ewart.) No history.

2. A portion of the dura mater and the subjacent left cerebral

hemisphere from a case of depressed and comminuted fracture
of the skull, in the parietal region (“ the fragments of which
were removed with the trephine”). There is inflammatory
thickening with blood extravasation over the surface of the
dura mater for a space about three inches in length by
two inches in breadth ; while the brain substance beneath
this shows extensive laceration. ( See also prep. No. 8, series I.)

3. “ The right-half of the brain exhibiting a large cavity occupying

a considerable portion of the middle and posterior lobes. It
was found filled with blood coagulum, some of which is now
seen in situ. There was hypertrophy of the left ventricle
of the heart.” (Ewart.)

4. A section from the right cerebral hemisphere showing an

apoplectic clot or extravasation rather larger than a walnut,
occupying the posterior inferior portion of the posterior or
occipital lobe, and extending forwards and inwards so as nearly
to reach the posterior horn of the right lateral ventricle. From
a native female, who is reported to have been admitted into the
Howrah Hospital with “ fever, headache, vomiting, loss of
appetite, and photophobia,” but who was quite sensible until
three days before her death, when she became quite mad”
(? maniacal). ( Presented by Assistant Surgeon Gopal Chunder
Roy, Howrah Hospital.)

5. The left anterior lobe of the cerebrum exhibiting an apoplectic

extravasation, the size of a five-shilling piece, with pulpy softening
(of a dark red colour) of the brain substance below it, to the
depth of about half an inch. The part of the anterior lobe
affected is its inferior surface,— that immediately overlying the
orbital plate of the frontal. The pia mater and arechnoid
are opaque and thickened from recent inflammatory effusion
(lymph), which also extended over the whole of the base of
the brain. On the upper surface of the brain there was
considerable fulness and engorgement of the vessels of the
pia mater, and numerous minute ecchymoses. From an English
seaman, aged 62, who died from scorbutic dysentery on the
fourth day after admission into hospital. There were no “ head
symptoms ” until within the last forty-eight hours, when he began
to talk incoherently, refused nourishment, and passed all evacu-
ations into the bed-clothes.

There were purpuric spots all over the skin of the legs and arms.
The spleen was found enlarged and soft (weighing ten ounces);
the pleurae were ecchymosed ; patches of blood extravasation
existed beneath the peritoneal coat of the small intestine, and
superficial, dark, blood-stained ulceration of the mucous mem-
brane of the large gut. ( See further, “ Medical Post-mortem
Records,” vol. I, 1874, pp. 471-72.)

6. A portion of the left cerebral hemisphere (middle lobe) externa

to the situation of the ganglionic centres (corpus striatum and

SERIES VIII.]

CEREBRAL HAEMORRHAGE.

245

optic thalamus), which were not involved. An encysted apo-
plectic clot is seen, about the size of a hen’s egg. It is
laminated _ and firm at the periphery, soft and dark at the
centre. The cause of the extravasation was probably embolism,
but no obstruction of any of the large cerebral vessels in its
neighbourhood could be actually demonstrated. On one of
the branches of the left middle cerebral artery a little aneuris-
mal tumour was discovered ( see prep. No. 80), but this was at
some distance from the site of this large extravasation. The right
brachial artery was blocked by a recent fibrinous embolus. From
an Armenian (male) patient, aged about 20, admitted into
hospital with right hemiplegia and acute valvular endocarditis,
the mitral (valve) ulcerated, and covered with warty vegetations,
&c. ( See prep. No. 102, series YI.)

7. The posterior cerebral lobes of a young adult native female, showing
large extravasations of blood (apoplexies) extending from the
cortex downwards into the deeper brain substance, and reaching
the posterior horns of the lateral ventricles on either side.
The coagula are recent, dark, and soft, each about the size of a
walnut. . There is red softening and considerable laceration and
destruction of the brain tissue around each clot for a distance
varying from half an inch to an inch.

Examined microscopically, the vessels of the pia mater immediately over the blood
extravasations, and also the more delicate cerebral arteries proper imbedded
in or skirting the site of these lesions, are found decidedly fatty — i.e with
minute oil granules and globules beneath the external coat, ' forming
opaque dark clusters and streaks along the course of these vessels. The
latter are soft and brittle; many are found ruptured, and others with
minute ecchymoses along their outlines, or surrounding portions of their
channels. The cerebral substance proper is highly granular; the nerve
hbres show molecular degeneration of the contents of the tubules.
Very few granule-cells and free nuclei are visible, but large numbers of
) ood corpuscles, entire or withered and altered; a few crystals of
hmmatoidin and much free molecular fat. No new growth is observed
J tie cause oi the apoplexies is therefore clearly attributable to fatty (not
atheromatous) degeneration of the cerebral vessels, and this, in turn, may

thlyi--ar°bablyv bt r!Farded i,s associated with granular degeneration of
kidneys, which affected both these organs to a very marked extent.

The patient was admitted into hospital insensible, with convulsive
movements of the upper extremities and occasional vomiting
fche died comatose about thirty-six hours after. The urine
was highly albuminous. No paralysis. (-See further, “Medical
rost-mortem Records,” vol. I, 1877, pp. 385-8G.)

A large apoplectic clot occupying the right middle lobe of the
cerebrum and reaching from the surface for fully two inches
mto t le brain substance. It is narrow at the periphery, becomes

“ as 11 1exte"ds M1™18* U just touches’ but d°es not
actually involve the right corpus striatum and optic thalamus
Atthepostenor inferior extremity of the left posterior cerebral
oue there was another apoplectic extravasation the size of a
nazeinut. From a native (Mahomedan) male, aged 40, who died

216

APOPLEXY.

[SERIES VIII.

in hospital. ( See further, “ Medical Post-mortem Records,”
vol. Ill, 1880, pp. G03-4.)

9. “ A fibrous tumour from the left hemisphere of the brain of an

Abyssinian (Mahomedan), aged 48, who died from apoplexy.”
(Ewart.)

This is an apoplectic clot, not a fibrous tumour, as above described.
It is ovoid in shape, and about the size of a hen’s egg. The
circumferential portion is firm ; towards the centre it is soft,
of brownish-yellow colour, and crumbles readily when incised or
pressed.

On microscopic examination, towards the periphery an imperfect kind of capsule
of delicate connective tissue can be distinguished, and still deeper also, an
attempt at fibrillation of structure; but the main bulk ot the little mass
consists of altered blood-cells, with plates of eholesterine, a few hajmatoidin
crystals, and many pigmented cells and granules.

10. A little cyst, the size of a pea, found imbedded about a quarter

of an inch from the surface, in the upper part of the anterior
extremity of the left anterior cerebral lobe. It was surrounded
by yellowish softening of the brain substance for a distance of
from half to three-fourths of an inch. The cyst-wall is composed
of delicate but well-formed connective tissue, and its contents
consist of soft, curdy or cheesy material, containing no formed
elements, but only granular and molecular fat, and a little
pigment matter. The bones of the skull were healthy, and
also all other parts of the brain. The cyst had no immediate
connection with any of the cerebral vessels, which were also
normal. It probably represents the remains of an old apoplectic
extravasation (an encysted apoplexy). — From an epileptic native
(male), aged 30, who died in hospital.

11. The right corpus striatum and optic thalamus of a Mahomedan

(male) patient, aged 50, who was admitted into hospital with
left hemiplegia and aphasia. The specimen shows a haemorrhagic
clot, about the size of a walnut, and of a yellowish -brown
colour, situated deeply at the junction of the above ganglia, but
chiefly involving the corpus striatum. The surrounding brain
substance is in a state of white softening for a considerable
distance. The delicate blood-vessels passing into this dis-
organised corpus striatum through the anterior perforated space—
i.e., branches of the right middle cerebral artery — were found,
on microscopic examination, thickened, brittle, and atheromatous,
and so also were the vessels supplying the striated body on the
left side.

The patient had syphilis when 20 years of age, followed by secondary
svmptoms for about four years afterwards. He was a ganja-
smoker, and the paralysis had come on suddenly, after smoking
a pipe of this drug, about ten days prior to his admission into
hospital. (See further, “ Medical Post-mortem Records,” vol. I,

1873, p. 44.) .

12. A specimen showing red haemorrhagic softening of the left coipus

striatum, this condition extending downwards to nearly the base

SERIES VIII.]

APOPLECTIC CYSTS.

217

of the brain, and backwards so as just to touch the optic thala-
mus. Multiple small circumscribed spots of similar softening
were found in other parts of the brain : e.g., in the right fissure
of Sylvius ; in the anterior fissure ; on the inferior aspect of the
left posterior cerebral lobe ; at the surface of the left half of the
cerebellum, &c. From a Hindu male, aged 30, who died in
hospital from chronic empyema, treated by drainage and carbolic
acid injections, &c. (See further, “ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 23-24.)

13. A section from the left corpus striatum. This bodjq when “ viewed
from the interior of the lateral ventricle, looked yellow, and its
outline concave instead of being convex. When incised a small
quantity of opaque serous fluid exuded, and the grey matter
around was somewhat softened.” It appeared, therefore, to
represent the remains of an old apoplectic clot. The patient,
a European gentleman, was known to have suffered from an
apoplectic seizure, and to have recovered from the same after a
change to Europe. On examining microscopically the brain
tissue around this lesion “ an increased quantity of "fat granules,
of varying size, were seen, and a few altered nerve-cells and
tubules.”

With this specimen are preserved the pons Yarolii, crura cerebri, and
medulla oblongata of the same case. A little to the left of the
median line, on the inferior surface of the pons, and correspond-
ing to the distribution of the branches of the basilar artery,
there is seen a patch of softening or ramollissement, from which,
in the fresh state, there was “ an escape of semi-liquid and
broken-down nerve tissue. The softening penetrates deeply into
the substance of the pons, affecting the upward fibres from the
pyramidal and olivary bodies.” (Ewart.) (Presented by Pro-
fessor J. Fayrer, m.d., &c.)

14.

115.

A portion of the brain with an old (apoplectic) cyst in the right
corpus striatum. It is about the size of a hazelnut, and
situated about a third of an inch below the ventricular surface
of the striated body, near its junction with the optic thalamus.
It contained a little pale serous fluid, and is lined by a delicate
membrane, upon which minute blood-vessels are seen to ramify.
Nearer the median line a small patch of thickened and cica-
tricial-like grey matter is also to be seen. From a European
male, aged 45, who was an inmate of the hospital for

about seven years, suffering from partial paralysis of the lower

limbs and of the left arm, with rigidity of the muscles of

these parts, some contraction of the fingers and toes,

inco-ordinate action of the muscles in the affected limbs, and
impairment of speech. He died from bronchitis and dysentery.

The right corpus striatum with a small rounded cyst imbedded in

i /r?m a native male’ a"ed about 50 (a mehter in the
Medical College Hospital), who had for about ten vears been

partially hemiplegic (right side), and died of pulmonary phthisis.

218

CEREBRAL SOFTENING.

[SERIES VIII;

The cyst-wall, as seen under the miscroscope, is composed of
delicate, closely-woven connective tissue, with a few capillary
vessels, thin-walled, granular and fattjr, and much molecular fat.
The contents are yellowish-white and cheesy, and consist of fat
globules and granules, with a few degenerate nerve-cells, frag-
ments of nerve- fasciculi, and a great abundance of cholesterine
plates. A little dark pigmentary matter (no true haematoidin
crystals) is also found amidst the fatty debris. The cyst is the
size of a small hazelnut. The brain tissue around it Avas in a
state of pulpy white-softening. The former appears therefore to
be the remains of a limited and circumscribed old blood extra-
vasation (encysted apoplexy). ( See further, “ Medical Post-
mortem Records,” vol. II, 1876, pp. 109-110.)

16. A section from the brain of a native female, aged 30, who died

from the gradual exhaustion attending a ver}r large abscess of the
liver, which was opened antiseptically, and treated by drainage,
&c. A patch of “ red-softening,” the size of a hazelnut,
and the result evidently of a small extravasation of blood
(apoplexy), is seen at the posterior third of the grey portion
of the left optic thalamus. A similar but larger patch of soften-
ing affected the under surface of the cerebellum on either side
of the posterior median fissure. No thrombosis or embolism
of the cerebral or cerebellar vessels could be detected: ( See

further, “ Medical Post-mortem Records,” vol. Ill, 1879, pp.
313-14).

17. A preparation showing a small extravasation of blood, a little

larger in area than a spilt-pen, in the pons Varolii, at about
its centre. It is> surrounded by pinkish softening, extending
doAvmvards to the base of the brain, forwards along the
superficial portions of the crura cerebri, and upwards into the
corpora quadrigemina. The corpora striata and optic thalami were
healthy. This apoplectic effusion seems to have resulted from
the rupture of several minute capillary vessels in the posterior
perforated space — branches of the basilar and posterior cerebral
arteries. The lateral and third ventricles were found filled
with sanguineous serum. There Avas no thrombosis or embolism
of the vessels at the base of the brain. From a native male,
admitted into hospital perfectly insensible and comatose, and
who died within forty-eight hours.

18. Portion of brain substance and superjacent dura mater from

the anterior lobe of the right cerebral hemisphere ; obtained
from a Hindu male, aged 33, Avho Avas admitted into hospital
Avith recent right hemiplegia. He stated that the paralysis
had come on quite suddenly about three weeks previously.
The day before he had walked into Calcutta and back to his
village, a distance of about thirty miles. In addition to the
paralysis of the right arm and leg, there was hcmi-ansesthesia
of the same side, and ptosis of the left eyelid. The patient had
suffered from syphilis a year ago. He died comatose on the
fifteenth day after admission.

SERIES VIII.]

CEREBRAL SOFTENING.

249

The portion of dura mater which covers the anterior aspect of the
right anterior cerebral lobe shows an opaque yellowish patch
of thickening, the size of an eight-anna piece. Its under
surface was adherent to the subjacent brain tissue. The latter
(also preserved) is in a state of “ yellow softening,” this con-
dition extending to the inferior surfaces of both anterior
cerebral lobes, on either side of the longitudinal fissure. In
these parts the cerebral substance was quite pulpy, and readily
broke down under a gentle stream of water.

The olfactory bulbs were much atrophied — in fact, had almost entirely
disappeared. The left optic nerve was inflamed and thickened,
but the right was healthy. The left motor oculi was also
enlarged, thickened, and highly vascular ; the right healthy. All
the other cranial nerves were normal. The whole of the left
crus of the cerebrum was diffluent. The corpus callosum and
fornix were soft ; the lateral ventricles distended with pinkish
serum. The corpus striatum and optic thalamus on the left side
were quite pulpy, and on section of a pale-yellow colour. The
corpus striatum on the right side was somewhat flattened and
atrophied, but both it and the thalamus were pretty firm in con-
sistency. The pons and medulla were abnormally vascular.
Almost the whole of the anterior, middle, and posterior lobes of
the cerebrum on the left side were found in a state of “ yellow
softening.” The other organs of the body were healthy. (See
also prep. No. 70.)

19. The left corpus striatum with a central spot of “ yellow softening,”

the size of a large pea. From an Irish seaman, aged 38,
who died from embolism of the basilar artery (see prep. No. 71).
All the vessels forming the Circle of Willis were atheromatous.
The patient was admitted insensible, and died within eight hours.
(See further, “ Medical Post-mortem Records,” vol. I 1874
pp. 273-74.)

20. A portion of the brain of an East Indian female, aged 65, showing
chronic (yellowish) softening of the right posterior cerebral lobe,
extending into the contiguous structure of the corpus striatum
and optic thalamus. The patient was admitted into hospital
with complete left hemiplegia, of long standing. The mental
faculties were not markedly impaired, and she remained sensible
until about the last 48 hours of life, when, becoming gradually
drowsy, she lapsed into coma, and thus died. All the vessels of
the Circle of Willis exhibited extreme opacity, softening, and
fatty degeneration. (See prep. No. 85.)

21. A preparation illustrating the extension of acute inflammation

from the internal ear to the adjacent portion of the middle
cerebral lobe, and eventuating in abscess of the brain. The
auditory canal in the left petrous bone has been laid open
throughout its extent, as also the tympanum. In the cerebral
substance immediately overlying these parts several small more
or less circumscribed abscesses are seen. No history.

22. A portion of the brain showing the cavities of two abscesses.

One, about the size of a pigeon’s egg, is situated in the substance

250

ABSCESS OF THE BRAIN.

[series VIII.

of the left optic thalamus ; the other, rather larger than a
pea, in the corresponding striated body. Both are distinctly
circumscribed, and have the appearance of being encysted by
a delicate capsule of connective tissue. They do not inter-
communicate. No history.

23. “ A preparation showing the cavity of a circular abscess, about two

inches in diameter, in the left hemisphere of the brain. From
a female who died in the lunatic asylum.” (Ewart.) The
excavation is situated in the left posterior cerebral lobe, and
apparently in close connection with, if not actually involving
the optic thalamus of this side. ( Presented by Dr. S. Cantor.)

24. An abscess cavity, as large as a hen’s egg, situated on the inferior

surface of the right anterior lobe of the cerebrum. Above it
is preserved the portion of the dura mater which was adherent to
the abscess, and lined the cribriform plate of the ethmoid and
adjacent portion of the orbital plate of the frontal. It is seen
perforated by a rounded soft growth, a prolongation upwards
of a myxomatous polypoid tumour, which filled the nares,
projected into the pharynx, and, absorbing the cribriform plate,
entered the skull. Cerebral meningitis, with the formation of
the above abscess was the result, and death rapidly ensued. — From
a native male, aged 25.

25. Abscesses of the brain. A portion of the right posterior cerebral

lobe exhibiting an abscess-cavity, the size of a hen’s egg, situated
about a quarter of an inch below the upper surface, and at the
posterior pointed or rounded extremity of this lobe. It was
filled with thick, greenish-yellow pus. Its outline is well defined,
and it is seen to be lined by a kind of pyogenic membrane.
Immediately around this large abscess several smaller ones are
seen, varying in size from a nutmeg to a pea. — From a
European sailor, aged 24, who died in hospital. (See further,
“ Medical Post-mortem Records,” vol. II, 1877, pp. 549-50.)

26. “ The cerebellum, at the centre of the superior surface of which a
part of the substance of the same has been destroyed by the
formation of an abscess.” (Ewart.) No history.

27. A portion of the brain of a semi-idiotic native lad, aged about

sixteen years, who died thirty-six hours after the removal of a
large fibroid tumour from the left thigh. The corpora striata
and optic thalami show considerable firmness and rigidity, the
medulla oblongata is the seat of sclerosis, affecting chiefly its
posterior columns, and passing upwards into the pons and left
optic thalamus.

Sections examined microscopically (after hardening' and staininaj exhibit consider-
able hyperplasia of the connective tissue (neuroglia) of the posterior columns
above their divergence from the cord, i.e., at the floor of the fourth ventricle.
Small, round, and fusiform cells are found distributed irregularly amidst
the proper nervous elements, — displacing them, and causing their atrophy.
A large number of * vacuolar ’ spaces are also observed, giving portions
of the sections a cribriform appearance. This latter change, however, is
most marked in the left optic thalamus. In the medulla some of these
vacuolar spaces seem to be associated with dilatation of lymphatic or capil-
lary vessels, — which enclose them in a kind of capsule. These spaces vary

series viii.] PIGMENTATION OF THE BRAIN.

251

in size from jig" to gig". Tlie changes above indicated appear to establish
undoubtedly the presence of disseminated “ grey induration ” or sclerosis.

28. Greatly atrophied anterior lobe of the brain, with a portion of the

investing dura mater, — from a native male, named Damoo, who
“ had lost a portion of the frontal bone some years before, and
suffered from epilepsy.” (Colies.) ( Presented by Dr. Fayrer.)

29. Portions of pigmented brain (malarial) from a native adult (male),

who died from remittent fever on the eighth day. He was
admitted into hospital in a low, delirious, and restless state. On
post-mortem examination, the vessels of the pia mater covering
the superior aspect of the cerebrum were highly injected. The
brain substance moderately firm ; puncta vasculosa more numer-
ous than normal. The other organs were also found more or
less congested ; the spleen in parts pigmented. The brain
throughout, but particularly the grey matter of the cortical
layer and that of the central ganglia, was of a dark leaden
colour. This may still be observed in the sections which have
been preserved,— taken from the surface of both cerebral hemi-
spheres.

30. Sections from the cerebrum and cerebellum showing an inordin-
ately dark leaden appearance of the grey matter, due to minute
or fine pigmentation accumulated within the minute'blood-vessels
of these parts, and also partially extraneous to them. Taken
from a native boy, aged 15, who had long suffered from malarious
fever, and died from erysipelas of the face and pyaemia.

31. Portions of the cerebrum and cerebellum from a highly pigmented

brain. In the fresh state the white substance had a dirty-
yellowish appearance, while the grey matter of the convolutions,
and of the central ganglia and medulla, was of a slate-grey
colour. The liver was also dark and pigmented. The spleen
weighed nine ounces. The patient, a native male, aged 50, died
from remittent fever. He was moribund when brought to the
hospital. ( See further, “ Medical Post-mortem Records,” vol. I,
1873, p. 70.)

•32. Sections from the upper surfaces of both cerebral hemispheres show-
ing a dark, leaden colour of the grey matter of the convolutions
due to abnormal pigmentation. The cerebellum was similarly
affected, and both the liver and spleen were enlarged, dark
and soft.

(E xamined microscopically, the pigment matter is seen to be finely granular, and
distributed chiefly along the course of distribution of the minute cerebral
vessels in the grey matter, but it also penetrates the white substance. The
blood found in the heart, post-mortem, contained much dark pigment matter,
either free or contained within leucocytes (melansemia).

From a native male, aged 14, who died in hospital. (See further,
“Medical Post-mortem Records,” vol. II, 1878, pp. 679-80.)

33. A vertical section through one lateral half of the brain and cere-
bellum to show the very darkly pigmented condition of the grey
matter, both that of the superficial convolutions and also of the
deeper seated ganglia, &c. The liver exhibited similar changes.

252

TUMOURS OF THE BRAIN.

[series VIII.

The spleen was enlarged, very dark and soft, weighed 14| ounces.
— From a native male (Mahomedan), aged 35, who died in
hospital from remittent fever. (“ Medical Post-mortem Records,”
vol. II, 1878, pp. 983-84.)

34. Sections from the right and left cerebral hemispheres and from
the cerebellum showing a dark-grey or leaden appearance (pig-
mentation) of the grey matter.

In microscopical sections, tbe pigment is found very dark, and granular or amor-
phous; it is seen following closely the outline of the minute capillaries in
the cortical or grey substance, and filling the minutest of these, having
apparently passed through those of larger size. In no case, however, does
the obstruction appear to be complete. Similar pigment matter is scattered
throughout the cerebral substance external to the vessels, and at some
distance from them, but in a surprisingly small amount as compared with
the dark-leaden colour of the grey matter. No other morbid change is
observed.

From a native boy, aged 14, who died, from remittent fever, with “ head
symptoms.” (u M^edical Post-mortem Eecoids, vol. Ill, 1880,
pp. 481-82.)

35. “ Several small tumours of the dura mater, pressing upon the

anterior lobe of the cerebrum, to which the dura mater is adherent.
The patient, John Cannon, suffered from epilepsy. Died 20th
January 1864.” (Colles.) .

The dura mater is much thickened and leathery in consistency, ihe
tumours referred to consist of small, imperfectly defined, nodular
masses, immediately beneath this membrane, and extending lor
about half an inch into the subjacent brain substance. They are
of o-liomatous structure— consisting of round, nucleated cells, ot .
almost uniform size, with mostly a scanty librillated inter cellular
substance, but in parts, e g., just beneath the dura mater, showing
much fibrous or connective tissue continuous with that ol the
latter, and very freely infiltrated with fat globules and crystals.

o0 portion of the brain with a tumour situated at thesuiface. The
latter is about the size of a walnut, is partially imbedded, par-
tially projects from the cerebral substance. It is invested by the
pia mater superficially, and has a delicate capsule which separates
it but not completely, from the surrounding parts. Examined
microscopically, it consists chiefly of round cells, with large, well-
developed, single nuclei, and a scanty fibrillated intercellular
material, which in parts forms a small-meshed reticulum. There
are also here and there, combined with the round cells, a few
fusiform or spindle-shaped nucleated cells. The capillary ves-
sel are large and numerous. The growth is probably a

“ glioma.”

TT 4. «« The natient showed svmptoms of insanity in his life-time, and

History. lh« ie , h. i;fo b his throat, in which he did not com-

nletSf succeed. The larynx was completely severed below the hyoid bone
lit the arteries escaped. The wound was progressing favourably, but the
ripnt was weak, and gradually succumbed. The tumour was found
^post-mortem at the top of the left hemisphere, on the side of the iong'-
til nal fissure. The patient had no cancerous or tuberculous deposit >n any
o£ part of the body, and his death was due to embolism ot the loft

SEMES VIII.]

TUMOURS OF THE BRAIN.

253

auricle, which was filled with a white clot of fibrin, firmly entangled in the
meshes of its wall. The veins were engorged on account of the obstruc-
tion, and the onward flow of blood must have been very limited. The
tumour appears to have exercised a sedative action on the heart, and deter-
mined the clotting.” (Note by Dr. Roy.)

( Presented by Dr. G. C. Roy, Civil Surgeon, Beerbhoom.)

37. “ Tumour from the cerebrum supposed to be gummy.” The

growth is of pinkish-white colour, two inches long by an inch
in thickness, and has a brain-like appearance and feel. Over one
surface, which is flattened, a portion of the pia mater is still
adherent ; the rest of the growth has no distinct investment of
any kind. On section it is seen to consist of two rounded
nodules, one, the size of a betel-nut, the other, rather larger.
These are separated by a band of delicate connective tissue from
three to four lines in thickness, which appears to be a continuation
of, or outgrowth from, the pia mater at the attached surface. A
condensed-looking yellowish rim surrounds each lobe, and appears
to be the line of demarcation between the opaque-white soften,
ing or degenerating portion of the growth, and its prolifer-
ating layer, which extended probably for some little distance
into the surrounding cerebral tissue.

Under tbe microscope, a very rapidly proliferating small round cellular growth is
observed, co^aining a small amount of fibrillated tissue. This "structure
is most marked at the peripheral portions of the nodules: the
new-formed tissue is more opaque and fatty-looking (degenerating)
towards their central portions. At the periphery also, a few blood-vessels,
some of considerable size, are found; none at the central portions of the
growth. The latter is probably a true gummy tumour or “ syphiloma ” of
the brain.

“ There was no recent history of syphilis in this man’s case, but there
appeared to be a node on the frontal bone.” He was a soldier
(■ Presented by Surgeon C. H. Joubert, General Hospital’
Calcutta.) ’

38. A portion of the brain of a native male patient, ao-ed 22,
admitted into hospital with hemiplegia of the right side, and
a history of syphilis. A small irregular-shaped morbid growth
is seen occupying the left optic thalamus and adjacent margin
ot the corpus striatum ; it also extends backwards into the
corpora quadrigemina and upper part of the left half of the
medulla. On microscopical examination, the structure of the
growth is found chiefly cellular, there being but little inter-
cellular tissue ; the cells are almost uniformly round, with single
large nuclei, and are from two to three times the size of blo°od
corpuscles. These cells surround small caseous nodules, varying
in size from a pin’s head to a pea, or a little larger • and
ramifying among them are seen small capillary and arterial
vessels. The caseous portions consist of granular and molecular
tat, and, in parts, of large “ granule cells.” The growth is
therefore probably gummatous in character.

139. A gummy tumour, the size of a pea, found on post-mortem
examination, situated close to the right optic tract. On section

264

GUMMATA.

[SERIES VIII.

it lias a yellowish colour, is firm in consistency, and surrounded
by a little fibrous tissue of reddish appearance.

On microscopic examination, sections exhibit a disintegrated, molecular, fatty debris
(cheesy matter), constituting the yellowish opaque nucleus above described.
This is surrounded by firmer material, consisting of round nucleated cells,
with a few blood-vessels, and a scanty intercellular or connective tissue.
The majority of the cell-elements are from two to three times the size of
blood-cells, some are smaller. They apparently belong to the. cerebral
neuroglia, which has undergone nodular, circumscribed proliferation here,
the central parts subsequently degenerating into caseous material, while
the periphery still shows well-formed new growth. These characters
confirm the opinion of the “ gummy’ nature of the tumoui.

From a European male, aged 61, who died in hospital. (See further,
« Medical Post-mortem Records,” vol. II, 1876, pp. 299-300.)

40. A portion of the right cerebral hemisphere (middle lobe), showing
a tumour, the size of a small orange, which is soft and broken
down towards the centre from blood extravasation.

On microscopic examination the structure appears to be gummatous.

It consists of irregular masses of small nucleated cells, mostly round, a few how-
ever spindle-shaped, with a little slightly fibrillated intercellular material.
Towards the centres these are seen to be undergoing atrophy, and resulting
in the formation of depots of granular fatty material, with pigment matter,
and the debris of disorganised cerebral nerves, ruptured blood-vessels, &c.,
in parts, also, consisting almost entirely of altered blood-corpuscles and pig-
ment matter, evidently the remains of large blood extravasations. There
is no fatty degeneration of the blood-vessels, but these are found either
thickened from an interstitial multiplication of the nuclei in their walls, or
are so atrophied and thinned that they present an almost structureless
outline and greatly narrowed calibre.

From a Mahomedan sailor (khelasi) who had suffered from syphilis,
and was subject to epileptic fits. He was admitted into hospital
with left hemiplegia, which had come on within the last few days
after a “ fit.” There was considerable indistinctness of speech;
the memory not affected. ($e<? further, “Medical Post-mortem
Records,” vol. Ill, 1879, pp. 95-96.) .

41. A small morbid growth, together with a section from the interior
surface of the right anterior cerebral lobe to which it was
adherent above, while firmly fixed below to the duia matei lining
the cribriform plate of the ethmoid. Examined microscopically,
the structure of the little growth is seen to consist of small
round, cells or nuclei, imbedded in either a granular, unformed
intercellular substance, or associated with slight fibrillation of
the same. In parts, also, only small amorphous granular-
looking foci are seen, as if the result of degenerative changes.
Towards the periphery several large capillary vessels are met
with ; at the centre these are small, indistinct, or obscured. The
whole growth is not larger than a nutmeg, and is probably

gummatous. _

From a native female, aged about 45, who died from epilepsy, (pee
further, “Medical Post-mortem Records,” vol. Ill, 18S0, pp.

42.

ibed

475-76.)

The pons Varolii and medulla oblongata with a circumscn
deposit or growth in the former, about the size of a small hazel-

SERIES VIII.]

TUMOURS OF THE BRAIN.

255

nut. From a native male, aged 20, who died in hospital from
pulmonary phthisis. The nodule is oval-shaped, and deeply
imbedded in the pons. It is opaque and cheesy at the centre,
gelatinous and semi-transparent at the circumference.

Examined microscopically, sections exhibit a structure composed of (1) a series of
coalesced minute granules (Pmiliary), slightly opaque from fatty metamor-
phosis at their centres, sparingly reticulated peripherally, where also small
nucleated lymphoid-looking cells or nuclei are observed in the meshes of
this reticulum ; (2) a few small arteries traversing or imbedded in the new
growth, some of which exhibit thickening and nuclear proliferation of the
perivascular sheaths; (3) a general proliferation or multiplication of the
cells of the neuroglia so as to form a nucleated growth chiefly at the
periphery of the granules, or in the paler portion of the caseous mass.
Many of these cells are large, granular, and multinucleated. These parti-
culars of structure, taken with the fact of true tubercle being found at
the apices of both lungs, the age of the patient, and the absence of
syphilitic history or evidence of syphilitic lesions, render it highly probable
that the nodule in the pons is truly tubercular.

43. A growth, the size of a pea, found in the left half of the medulla
oblongata, in the olivary body, and in almost the exact position
usually occupied by the “corpus dentatum.” It was readily
nucleated from its position. On section it is moderately firm,
yellowish, and cheesy-looking towards the centre ; dull white at
the periphery^ It- is seen to consist (under the microscope) of
small, round, lymphoid-looking cells in various stages of
degeneration, crowded together and commingled with fragments
of nerve-fibre and delicate connective tissue, atrophied capillary
vessels, a small amount of blood-pigment, a few corpora amylacea,
and much dark, granular, and molecular fat. The little growth
appears therefore to be tubercular, the tubercle bavin" under-
gone central caseous metamorphosis.

The patient, a young native adult (male), died from tubercular menin-
gitis. There were, also miliary granulations at the apices of
both lungs, chronic strumous peritonitis, and incipient tuber-
cular infiltration of the intestinal mucous membrane. (See

further, “Medical Post-mortem Records,” vol. II, 1878 nn
743-44.) ’ ’

44.

45.

A. P0rtl0n of the cerebellum showing a small soft nodule, the
size of a hazelnut, situated just below the inferior surface of
the right lobe. On microscopical examination this proved to be
a secondary enkephaloid growth, associated with yellow softenin"
(tatty degeneration) of the included and surrounding cerebellar
substance.— From a native female, aged GO, who died from
enkephaloid carcinoma of the liver.

Sections from the right and left cerebral hemispheres showing
dark sooty deposits of melanotic cancer. They are situated
just beneath the pia mater, and are very soft and pulpy in
consistency. Their microscopic structure is that of true en
kep haloid carcinoma, only altered by pigmentary infiltration
Similar deposits were found in the liver, lungs, kidneys, bones &c
1‘ rom an East Indian (male), aged 44.

256

SANGUINEOUS CYST.

[8EBIES VIII.

46. “ A foetus, about twenty-six weeks old, which has a very large

tumour on the head, apparently continuous with the cranial
contents.”

The tumour is cystic in character, ovoid in shape, and a little larger
than the foetal head, from which it projects in the situation of
the posterior fontanelle. On examination it is found that the
walls of the cyst are composed externally of greatly thickened
integument (the scalp), destitute of hair, except for a short
distance above the pedicle by which it is attached to the skull ;
internally, by a prolongation of the dura mater lining the
cranial cavity. It contains about half a pint of brownish fluid,
with soft, pulpy or semi-solid material, i.e. cerebral or brain
substance, similar to that filling the cranial cavity, with which
it freely communicates. The cyst is therefore a true enkephalocele.
(Presented by Dr. Cleghorn, Officiating Civil Surgeon, Cawnpore.)

47. A portion of the dura mater and falx cerebri from the frontal

region of the skull, showing a perforation of the longitudinal
sinus by a small, but sharp, iron nail, which is seen in situ , the
sinus being indicated by a glass rod. There is no record of
any inflammatory or other morbid condition of the brain or
membranes observed in the fresh state. The specimen is from
a dissecting-room subject (native male), and nothing was there-
fore discovered as to the mode or cause of this injury. ( See
also prep. No. 1G, Series I.) ( Presented by Assistant Surgeon
Chunder Mohun Ghose.)

48. A large sanguineous cyst, found completely covering the right

hemisphere of the brain. From a patient, Pedro Visconti,
a Malay, who died from epilepsy. It was said that he had
suffered from the disease for about four years, getting “ fits ”
two or three times a month at irregular intervals. There was
an almost incontrollable tendency to masturbation. The bones
of the skull were healthy, but the dura mater was unusually
adherent to the calvarium, and, on incising this membrane, the
blood-cyst forming the preparation was found resting on the
pia mater, but separable from it. The under surface of the
cyst-wall showed numerous branching blood-vessels derived from
the pia mater, and its upper surface was glued to the dura
mater by a little recent inflammatory exudation. The blood
extravasation had therefore virtually taken place in the “ cavity
of the arachnoid.” The cerebral convolutions on the right
side were much flattened. The cyst-wall is from two to three
lines in thickness, and composed of soft and delicate connective
tissue. On being laid open, the contents of the cyst were found
to consist of blood only— partly coagulated, but mostly still
in the fluid condition. (See further, “ Medical Post-mortem
Kecords,” vol. I, 1874, pp. 371-72).

49. “ Specimen showing great thickening and adhesion of the dura

mater. In some places the section demonstrates it to be
fully one-fourth of an inch in diameter. The pia mater is also seen
to be dull, opaque, and altered. This portion of brain was
removed from a native male subject in the dissecting-room,

series rat] DISEASES OF CEREBRAL MEMBRANES.

' 257

aged about 40. The thickening of the dura mater was
opposite to the superior surface of the middle and anterior
lobes. The anterior part of the anterior lobe of the left side
was soft and altered in appearance. The ramollissement in-
volved the whole of the anterior lobe, continuing in part as far
back as the middle of the middle lobe. Internally, its extent
was bounded by the great longitudinal fissure. Superiorly, it
reached the surface of the left hemisphere. Interiorly, it
extended to within half an inch of the level of the left corpus
striatum.” (Ewart.) {Presented by Assistant Surgeon Jagga-
bandu Bose.)

50. “ Base of the brain of an adult, showing inflammatory alteration
of the arachnoid and apoplectic effusion, more or less diffused,
over the pons V arolii and medulla oblongata. (Ewait.) The
pia mater in the fissures of Sylvius and on the inferior aspect of
the anterior and middle cerebral lobes is covered by a thick
layer of recent yellowish inflammatory exudation (lymph), which
extends backwards also over the under surface of the pons,
medulla, and cerebellum (basal meningitis). {Presented by Pro-
fessor J. Jackson.)

51. A preparation showing a portion of the dura mater of the skull

with a thickened hernial protrusion of the same at about its
centre. This part is coated with inflammatory lymph, and
protruded during life through a trephine hole in the left
parietal bone. From a native girl, who sustained a fracture of
the left parietal, but showed no “ head symptoms” until some days
after admission, when rigors with constitutional disturbance
ensued. About half a drachm of pus was evacuated from
between the bone and dura mater after removal of a circle of the
former by the trephine. Pus was detected in the diploci, and,
after death, was found to smear the upper surface of the
dura mater around the trephine hole, as well as that portion which
projected through the latter. The under surface of this membrane
is also seen to be coated with lymph. There was, however, no
inflammation or suppuration of the brain substance proper.
{See also prep. No. 10, Series I.) {Presented by Professor
J. Fayrer.)

52. Sections from the right and left hemispheres of the brain showing

waxy-like thickening and opacity of the arachnoid and pia mater,
the result of acute meningitis. In the fresh state these mem-
branes were found covered with recent sero-purulent effusion,
which also extended to the base of the brain.

53. Traumatic meningitis. A portion of the dura mater of a native

boy, aged five years, admitted into hospital on the 22nd October
1872, with a contused wound over the left parietal bone,
caused by a buggy-wheel having passed over his head. The
scalp around the wound sloughed, leaving a surface of bone
denuded, about three inches long and an inch and a half wide.
This necrosed, and the child then developed “head symptoms.”
He was trephined in two places through the dead bone. A
small quantity of pus was found between the skull and the

258

ACUTE MENINGITIS.

[SEBIES VIII.

dura mater. The boy died on the 15th November. On post-
mortem examination pus was found spread over the left hemi-
sphere of the cerebrum. No abscess in the brain.

The specimen shows (1) granulations sprouting from the outer surface
of the dura mater to fill the trephine holes ; (2) pus outside
this membrane, on the left side, between the median line and
the trephine holes ; (3) purulent effusion on the inner aspect of
the dura mater, over the left side of the falx cerebri. ( Presented
by Professor J. A. Purefoy Colles.)

54. Acute cerebro-spinal meningitis. Sections from the superior

surface of both cerebral hemispheres showing an opaque and
thickened condition of the arachnoid and pia mater, with an
obscuring of the vessels of the latter by a recent sero-fibrinous
effusion into its meshes. The membranes of the spinal cord
were similarly affected ( see prep. No. 104). — From a native
male, aged 30, who died in hospital.

55. Acute cerebral meningitis. Sections from the right and left

cerebral hemispheres showing a dull, opaque, and thickened
appearance of the membranes (arachnoid and pia mater), due
to a copious superficial and interstitial exudation of recent
lymph. The congested vessels of the pia mater and the sulci
between the convolutions of the brain are obscured by the
same. — From a native male, aged 48.

50. Sections from the convex surfaces of both cerebral hemispheres,
illustrating the morbid anatomy of acute meningitis. — From
a native female, aged 22.

The dura mater was healthy. The pia mater and arachnoid are both
very opaque from the presence of considerable recent inflamma-
tory effusion (yellowish lymph) into the meshes of the former.
This condition extended to the base of the brain, but there was no
evidence of any tubercular deposit associated with it. The
blood-vessels of the pia mater are greatly injected, and were
filled with dark fluid blood. They are here and there obscured
from the intensity of the inflammatory exudation. (“Medical
Post-mortem Records,” vol. II, 1878, pp. G55-5G.)

57 Thickening of the dura mater, with interstitial calcareous infiltra-
tion of a portion of the same overlying the right anterior cere-
bral lobe. — From a subject in the dissecting-room.

58. Extensive tubercular meningitis. The pia mater is abnormally

thickened, opaque, and densely crowded with small miliary
granulations, which are seen to follow more or less intimately
the course and distribution of the congested blood-vessels of this
membrane. — No history. ( Presented by Professor Allan Webb.)

59. A portion of the pia mater from the superior surface of the left

cerebral hemisphere exhibiting granular or miliary tubercular
deposit, distributed chiefly along the course of the blood-vessels.
The pia mater investing the opposite hemisphere was similarly
affected, as also that lining the fissures of Sylvius and the
general surface of the base of the brain. Besides which, in the
last situation, there was considerable recent inflammatory effu-
sion (yellowish lymph) associated with the deposit. Both lateral

eries VIII.]

TUBERCULAR MENINGITIS.

259

ventricles were found distended with pale-coloured serum ; the
corpus callosum and fornix exceedingly soft, — almost diffluent,
and the corpora striata and optic thalami so much so as to cut
like butter. Tubercles, chiefly miliary, were found profusely
infiltrating the substance of the superior and middle lobes of the
right lung, and both lobes of the left lung. A small vomica —
the size of half a walnut — was situated at the apex of the latter.
Scattered tubercular deposit, in the form of yellowish-white
opaque hard granules, was discovered in both kidneys, and
the solitary glands in the ileum were tumefied and swollen.

The patient, a young native lad, was admitted into hospital in a kind
of cataleptic condition,— semi-conscious, but passing urine and
foeces involuntarily. About forty-eight hours after admission
he had, quite suddenly, several convulsive fits, followed by coma,
with stertorous breathing and dilated pupils, and thus died.

60. Tubercular meningitis. A portion of the pia mater from the
base of the brain of a child, aged twelve months, who died from
acute hydrocephalus. Minute miliary granules are seen thickly
* distributed, especially along the course of the minute blood-
vessels, throughout the portion of membrane preserved. This
condition was associated with the presence of inflammatory
effusion (lymph) over the whole of the upper surface of the
brain ; at the base, particularly in the fissures of Sylvius,
and also extending along the velum interpositum and choroid
plexuses into the lateral ventricles. The brain itself was soft
and pale.

The lungs were diffusely infiltrated with tubercular granulations. The
mesenteric glands were cheesy.

The little patient, when received into hospital, had the following
symptoms : — “ Constant vomiting, flatulency, and looseness of the
bowels, great restlessness, moving the head on the pillow from
side to side constantly, and fever with exacerbations regularly
towards the evening. He gradually became weaker and more and
more exhausted, but lived for twenty-four days after admission.”
There was a strumous family history, and a brother had died,
at the age of four, from diffuse tuberculosis.

61. A soft, spongy intra-cranial tumour, the size of a small orange,
flattened from above downwards, rounded laterally. It originates
from the inner surface of the dura mater, and was imbedded
in the upper part of the left posterior lobe of the cerebrum,
near the median line. The skull-cap was perforated by the
growth, and it appeared beneath the scalp as a soft, clastic,
smooth swelling. Examined in the fresh state, it had a blotched
appearance, cherry-red in parts, yellowish in others, and on sec-
tion was spongy and partly cystic, the cysts containing yellowish
fluid, no blood. On microscopic examination, the solidest
portions of the growth consist of small round nucleated cells, a
few spindle-shaped, and much granular fatty infiltration of the
whole structure ; here and there some delicate strands of fibrous
or connective tissue. The growth is therefore a round-celled
sarcoma or glioma. — From a native male, aged 30.

200

TUMOURS OF THE DURA MATER.

[series VIII.

62. The vault of the skull from the above case showing the large

perforation produced by the tumour, situated at the junction of
the sagittal and lambdoid sutures, and involving the posterior
superior angles of both parietal bones. ( Presented by Professor
H. C. Cutcliffe.)

63. A tumour “ found pressing upon the back part of the right middle

lobe of the brain, at its superior surface, and adherent to the
superjacent dura mater.” The growth is the size of a potato,
and of a yellowish-white colour ©n section. It is slightly lobu-
lated and soft in consistency. Consists of small round, and a
few spindle-shaped cells, with a very scanty, and not uniformly
distributed intercellular substance or stroma of fine connective
tissue. Contains large capillary vessels. Is probably, therefore, a
glioma. ( Presented by Assistant Surgeon Gopal Chunder Roy,
Howrah.)

64. A portion of the dura mater of the brain of a Madrassee, Abdoolla,
with a tumour developed from it in the left frontal region. It
is somewhat “ quadrangular in shape, and measures about four
inches in each diameter. Anteriorly and interiorly, the tumour
is flattened out till it merges in the normal dura mater ; but post-
eriorly and superiorly the growth is much thicker, and terminates
abruptly in the healthy membrane. It is, in the thickest part,
about an inch in diameter, very hard, but slightly elastic to the
touch. Its outer surface is of a dull opaque colour, and convex.
Its inner surface concave, and matted with the arachnoid,
pia mater, and convolutions of the brain over the antero-lateral
and superior half of the left hemisphere. On making a
longitudinal section of the growth, it cuts like gristle. On
microscopical examination it is found to consist of nothing
but an intricate network of coarse fibrous tissue, with a
quantity of granules adhering to the fibres here and there. It
would therefore appear to be merely an exaggerated growth and
augmentation of the tissues pre-existing in the dura mater.

The corresponding frontal and parietal bones of the calvarium were
found to be on an average about thrice as thick as those parts
of the opposite and unaffected side. The outer and inner tables
much hypertrophied, and the diploe more dense than natural.”
(Ewart.)

The growth is, as above described, principally fibrous, but, in portions of sections
made for microscopic examination, there are isolated masses composed of
small round cells only, rather larger than blood corpuscles, and with
distinct large nuclei. These are closely applied together at the centre,
show a sparingly fibrillated intercellular tissue at the periphery, and gra-
dually disappear as the structure becomes more fully formed, and consists,
as the main bulk of the tumour does, of interlacing bundles of fibro-
elastic tissue. This appearance, taken together with the remarkably
hypertrophied condition of the calvarium ( see prep. No.. 4, Scries II),
renders it highly probable that the growth is syphilitic, i.e., gummatous
in character. ( Presented by Dr J. Fayrer.)

65. The dura mater showing great thickening of its left half, which

was firmly adherent to the calvarium, especially in the parietal
and frontal regions. On its inner surface is seen a gelatinous-

BUIES VIII.] OSTEOPHYTES OF DURA MATER.

261

looking, yellowish-pink, partially organized false membrane,
about one-eighth of an inch in thickness, three inches in length,
and an inch and a half in breadth. This membrane, together
with a small fibroid growth (the size of a small hazelnut) pro-
jecting from its under surface, intervened between the dura
mater and the pia mater covering the central parietal convolu-
tions of the brain. The bones of the skull were very massive
and thick. The right middle cerebral artery in the fissure of
Sylvius was considerably thickened, contracted, and opaque for
about half an inch from its origin, and the portions of the
anterior and middle lobes of the brain bounding this fissure in
front and behind were found softened and yellowish. There
was an old depressed cicatrix in the right corpus striatum, which
was also flattened and atrophied.

The other parts of the brain were healthy. The small growth developed
from the dura mater is found, on microscopic examination, to
be composed of imperfectly formed white fibrous tissue,
directly continuous with the structure of the false membrane
above described. All these changes appear to be syphilitic.

From an East Indian female, aged 40, who died in hospital from
epilepsy.

(See further, “ Medical Post-mortem Records,” vol. Ill, 1880, pp. 711-12.)

66. A small fibroid-looking growth found, on post-mortem examin-

ation, attached at about the centre of the inferior margin of the
falx cerebri. There were no indications of the presence of this
tumour during life. It is about the size of a nutmeg ; has a
distinct fibrous capsule continuous with the proper structure of
the falx. On section it is somewhat soft and spongy at the
centre ; firmer at the periphery. Its structure consists of white
fibrous and elastic tissue chiefly, but imbedded in the same are
numerous “corpora amylacea,” a few flat and spindle-shaped
epithelial cells, some small round cells and nuclei, with free
mucoid and fatty granules. The little growth is therefore a
(so-called) “psammoma.” — From a native female, aged 50, who
died from dysentery.

67. Osteophytes of the dura mater. This membrane presents, on the

right side of the falx cerebri, and in close proximity to the longi-
tudinal sinus, a flattened bony spicule, an inch in length, a third
of an inch broad, and two to three lines in thickness. A second
similar but smaller bony growth is seen a little below and to the
right of the above, intimately connected with the inner or
under surface of the dura mater ; and a third, rather larger than
a wheat-grain, still further to the right, also fixed to this mem-
brane.

From a native male (Mahomedan), aged 40, who died from cerebral
apoplexy (prep. No. 8.) ( See further, “ Medical Post-mortem

Records,” vol. Ill, 1880, pp. 603-4.)

: 68. Atheromatous circle of Willis, with thrombosis of the basilar
artery.-r-From a European gentleman, who died from cerebral
softening. (See prep. No. 13.) (Presented hj Dr.Fayrer.)

262 DISEASES OF CEEEBKAL VESSELS. [series vm.

69. A preparation of the circle of Willis, exhibiting embolism of the
right internal carotid and middle cerebral arteries, from a patient
who died with left hemiplegia. ( Presented by Dr. T. It. Lewis,
General Hospital, Calcutta.)

70. The circle of Willis, from a native male (Hindu), aged 33, who

died from extensive yellow softening of the left anterior, middle,
and posterior cerebral lobes, and of the corresponding corpus
striatum and optic thalamus (see prep. No. 18). There was
right hemiplegia and ptosis of the left eye-lid. The symptoms
had set in suddenly, and death occurred (from coma) within six
weeks of the attack. The patient had suffered from syphilis twelve
months previously. The left middle cerebral artery is seen blocked
by a firm, decolourised, fibrinous coagulum (thrombus) from
its origin to its primary subdivisions. The left anterior
cerebral is similarly occluded, and also a portion of the right
anterior cerebral. The left posterior cerebral artery is com-
pletely obstructed, but the left posterior communicating artery
remains free. On the right side, the middle and posterior
cerebral arteries and the posterior communicating branch
are all healthy, and contained only a small quantity of fluid
blood.

71. Vessels forming the circle of Willis extensively diseased ; opaque,

thickened, and atheromatous. The basilar artery, at about its
centre, is completely plugged ; the embolus (indicated by
bristles) is firm, pale-pink, and decolourised. In the fresh state
was seen to be succeeded by dark, thread-like coagula — thrombi —
reaching from the point of obstruction forwards to the origins
of the posterior cerebral arteries, and backwards into the verte-
brals. At the spot where the plug has been arrested, the walls
of the artery present a very distinct opaque-white bulging
(the size of half a pea), — an aneurismal-like condition. The
right posterior cerebral and superior cerebellar arteries are
occupied by moderately firm dark coagula, their walls irregularly
spotted opaque- white. The right middle cerebral shows much
the same appearances. The left anterior, middle, and posterior
cerebrals are collapsed and empty, and only about half the size
of the vessels in the opposite side. Their walls are atheroma-
tous. The left middle cerebral, at the commencement of the
fissure of Sylvius, exhibits a minute rent or rupture (shown by
a fine glass-rod), and appears to have given way under the
unequal pressure and volume of the blood-current in the attempt
to establish a collateral circulation.

In this case both choroid plexuses in the descending horns of the lateral
ventricles showed marked cystic degeneration, and are preserved with
the atheromatous vessels.

The aortic valves and lining membrane of the aorta were atheromatous. The
heart weighed 11 ounces. There was an indistinct cicatrix on the frenum
preputii.

Taken from an Irish seaman, aged 38, admitted with symptoms
of epilepsy, to which succeeded those of profound coma. (See)

SERIES VIII.]

THROMBOSIS AND EMBOLISM.

263

further, “ Medical Post-mortem Records,” vol. 1, 187 4-, pp. 273-74,
and also prep. No. 19.)

72. The circle of Willis from the base of the brain of an aged East

Indian woman (age 80), who died from accidental carbolic acid
poisoning. All the vessels are more or less diseased — atheroma-
tous. The left anterior, middle, and posterior cerebral, and
the left posterior communicating arteries are plugged by firm
pale-red eoagula. In connection with the middle cerebral is
also seen a little sacculated aneurism, the size of a pea, filled
with soft dark coagulum. The corresponding arteries on the
right side were occupied by fluid dark blood only, and presented
an unusually dilated and tortuous condition.

The brain itself was firm, smelt strongly of carbolic acid. The vessels
of the pia mater were intensely engorged and ecchymosed, and
the cerebral substance generally was abnormally hypenemic.
{Presented by Professor C. 0. Woodford, h.d., &c.)

73. Circle of Willis showing a firm, decolourised, fibrinous clot impacted

in the right vertebral artery, extending forwards into the basilar
for a short distance, and also backwards into the left vertebral.
All these vessels appear to be slightly thickened and opaque.

Taken from a native male patient, aged 45, admitted into hospital with
symptoms of cerebral apoplexy. He was a “ ganja-smoker,” and
was taken ill suddenly, with convulsions, passing into coma and
complete insensibility, in which state he died. ( See further,
“Medical Post-mortem Records,” vol. I, 1875, pp. 527-28.)

74. The circle of Willis from a European female, aged 40, who died of

cerebral softening. The basilar artery is slightly opaque and
thickened. It is seen obstructed by a fibrinous thrombus, about
the size and shape of a rice-grain. The right posterior, middle,
and anterior cerebral arteries are dilated ; the corresponding
vessels of the opposite (left) side are contracted and small.

75. Circle of Willis from the base of the brain of an East Indian

(male), aged 43, admitted into hospital completely paralysed
and insensible, and who died a few hours after. The commence-
ment of the right middle cerebral artery is opaque and dilated.
It is filled by firm decolourised coagulum (an embolus), which
extends in the form of softer and darker thread-like thrombi
along the channel of this vessel for a distance of quite an
inch, and into the right anterior cerebral and anterior com-
municating arteries, completely obstructing them. The left
anterior cerebral is collapsed and empty. The left middle
cerebral contains a moderately firm, but dark clot. The right
posterior cerebral is also firmly occluded.* The left correspond-
ing artery free. The basilar and vertebrals quite pervious.
The thickened and opaque condition of the right middle cerebral,
at the point of impaction of the embolus, seems to be due to
secondary inflammatory changes, for, under the microscope, no
fatty degeneration of the walls of the vessel could be detected,
nor any similar change in the minute radicles given off' by it

* Much of the obstructing material has dropped out under maceration.

264 THROMBOSIS AND EMBOLISM. [sebies viii.

in this situation, and no atheroma of any of the other arteries
forming the circle of Willis.

The meninges of the brain were found highly injected; the vessels of the pia
mater gorged with dark venous-looking blood. The convolutions of the
right hemisphere were flattened and sunken, and the whole of the cerebral
substance very soft. No inflammatory exudation into or over the
meninges existed ; but, as regards the brain pulp itself, the right corpus
striatum, and to a less extent the right optic thalamus, were found in a
state of acute red-softening, of purplish colour, and minutely ecchymosed,
this condition Gradually fading away in the substance of the middle
cerebral lobe immediately adjoining these ganglia. The injected and
abnormally vascular condition of the cerebrum extended backwards into
the pons and medulla. «

76. Circle of Willis showing complete occlusion of the left anterior

and middle cerebral arteries by an ante mortem fibrinous clot
(thrombus), which is decolourised and adherent to the walls of
these vessels. Secondary thrombi were found proceeding into
the branches of both these arteries ; in the former, reaching the
upper surface of the corpus callosum, in the latter, the outer
extremity of the .fissure of Sylvius.

Numerous similarly occluded, minute, capillary vessels were found
passing through the anterior perforated space into the anterior
and middle cerebral lobes. The whole of the anterior lobe and
the left corpus striatum were in a state of yellow-softening —
almost diffluent.

The primary thrombus examined microscopically exhibited only degenerating or
disintegrating blood-corpuscles, with fibrinous filaments and fatty
granules, — no specific cell elements (no cancer cells, &c.)

From a native (Mahomedan) female, aged about 45, who died from
scirrhus of the liver, and with symptoms of brain softening.
(See further, “ Medical Post-mortem Records,” vol. II, 1877,
pp. 357-58.)

77. Embolism of the basilar artery. The embolus consists of a small,

hard, opaque-white body, the size of a rice-grain. It is impacted
in the basilar just after its formation by the union of the two
vertebral arteries. Secondary thrombi extend on either side of
it into the latter arteries, and also, filling the basilar itself, pass
into the posterior cerebrals for a short distance.

Examined microscopically, the embolus exhibits a laminated fibrous appearance,
with a few strands of elastic tissue, and much dark granular and molecular
fat— appearances which closely resemble the condition of atheroma as
affecting the larger arteries, &c. ; and it therefore seems very probable
that the little rice-grain-like particle is a fragment of an atheromatous
patch, either from the aorta (which was thus diseased in this case) or
from some other large vessel ; that it has been carried on in the circu-
lation, and at last impacted in its present situation.

The patient, a native male, aged 45, was admitted with “fever,”
supposed to be malarial. The day after admission he suddenly
became unconscious, with dilated pupils, obstructed and ster-
torous breathing, loss of sensation in the lower extremities, and
marked rigidity of the upper limbs. All these conditions
persisted, the respiration becoming more and more embar-

series viii.] ANEURISM OF CEREBRAL ARTERIES.

265

rassed, until death took place about forty -eight hours after their
onset.

78. Thrombosis of a large branch of the left middle cerebral artery.

This condition was associated with softening of the anterior
extremity of the middle lobe of the cerebrum on the same side,
and hemiplegia (with aphasia) of the opposite or right side of
the body.

The case of a native male, aged about 65, who died in hospital. ( See
further, “ Medical Post-mortem Records,” vol. Ill, 1879,
pp. 25-26.)

79. The circle of Willis from the base of the brain of a Malay patient

(male), aged 40, who died from pneumonia, complicating right
hemiplegia. The latter bad existed for about four months prior
to death. There was no aphasia. The tongue was slightly
deflected towards the left side. No loss of sensation in any part
of the body.

The anterior half of the basilar artery is seen occupied by a firm, decol-
ourised, fibrinous thrombus, which extends a short distance into
each posterior cerebral artery. The whole of the former vessel
is much contracted. The inferior surface of the pons (upon
which the basilar lay) was softened, but there was no change in
any of the other cerebral centres. All the arteries composing
the circle of Willis are slightly thickened and atheromatous.
The whole of the arch of the aorta was similarly affected, and to
a very marked degree. ( See further, “ Medical Post-mortem
Records,” vol. Ill, 1880, pp. 487-88.)

80. An aneurism of one of the branches of the left middle cerebral
artery, found lying close to the surface, at the extreme outer
edge of the fissure of Sylvius. A small quantity of extravasated
blood was found around the little (pea-like) tumour, and was
evidently due to a minute rupture of the sac, which may be
readily distinguished in the preparation.

From an Armenian (male) patient, aged 20, suffering from valvular
disease of the heart (both mitral and aortic), and who died from
a large apoplectic extravasation into the left middle cerebral lobe
{see prep. No. 6), but apparently unconnected with the rupture
of this little aneurism.

The vessels constituting the circle of Willis itself do not appear to be
diseased.

81. The vessels forming the circle of Willis at the base of the brain,

showing slight thickening and opacity of their walls from
atheromatous changes. There is also a little aneurism — the
size ol a pea attached to, and developed from, the anterior
communicating artery. The sac is well formed, was entire,
but accidentally cut into during dissection. It contained a
little laminated fibrinous clot, and some fluid blood.

The subject was a native female, a prostitute, aged 35, who died from
chrome Bright’s disease, with great hypertrophy of the heart

&c. ( See further, “ Medical Post-mortem Records,” vol I 1875*
pp. 943-44.) ’ ’

266

ATHEROMATOUS DEGENERATION. [series vm,

82. Atheromatous cerebral vessels from the base of the brain of

a European (male), aged 56, who died while under treatment
for a small carbuncle on the nape of the neck. The aorta and
other vessels were found similarly diseased; the kidneys much
contracted, and in a state of granular degeneration.

83. Atheromatous degeneration of the arteries forming the circle of

Willis, from a female, aged 52, who died of haemorrhagic
apoplexy. Along all the larger vessels are observed small patches
and dots of thickening affecting their walls, and presenting a
yellowish-white colour. This is especially well marked in the
basilar.

84. Atheromatous degeneration of the circle of Willis. The opaque
yellowish-white deposit or change in the coats of the vessels is
well seen in the basilar, the middle and anterior cerebrals.

From a female, aged 50, who died from cerebral apoplexy.

The patient was brought into hospital two hours before death. She
was comatose, and insensible ; there was hemiplegia of the right
side ; the breathing stertorous.

On post-mortem examination a large fresh clot of blood was found in the
left lateral ventricle, the optic thalamus on this side quite softened and
disintegrated, the septum lucidum ruptured, and the right lateral ventricle
tilled with fluid blood. The haemorrhage was evidently due to the giving
way of several small branches of the left middle cerebral artery.

Both cavities of the heart were hypertrophied and dilated,— the left more than
the rrnht. There was much atheromatous thickening of the lining
membrane of the aorta. The kidneys were fatty and slightly granular.

85. Atheromatous circle of Willis from an East Indian female, aged
65, who died in hospital from chronic (yellow) softening of the
right posterior cerebral lobe, involving, also, portions of the right
optic thalamus and corpus striatum ( see prep. No. 20).

The vessels are all seen to be opaque and thickened ; their coats marked
by milk-white, or yellowish patches, spots, or streaks.

Several minute vessels, from the anterior and posterior perforated spaces were
examined microscopically, and exhibited very marked fatty infiltration, and
softening of their walls. In the minutest branches fine, dark globules
and granules of fat were seen, forming disseminated deposits beneath the
external coat, and causing an irregular bulging of the same in these
situations, giving the affected vessels a varicose outline. The muscular
coat was also greatly obscured by similar deposit.

86 Highly atheromatous circle of Willis. The arteries, especially the
basilar and middle cerebrals, are rigid ; their walls thickened, and,
at irregular intervals, marked by opaque, milk-white, or yellowish
spots and minute patches of atheromatous degeneration.

From an East Indian female, aged 60. The whole of the aorta (thoracic
and abdominal) showed similar (atheromatous) changes, ine
kidneys were small, contracted, and granular.

87. Calcareous degeneration or calcification of the vessels at the base

of the brain. — From an East Indian female, aged /0.

88. Simple serous cysts of the choroid plexus found in the lateral

ventricles of the brain of a native female, aged oo, who died
from morbus Ilrightii.

seuies tiii.] DISEASES OF THE SPINAL CORD.

2G7

The cysts vary in size from a sago-grain to a large pea ; have thin
transparent walls of very delicate connective tissue, and contain
clear limpid serous fluid.

89. A cystic condition of the choroid plexuses, in the lateral ventricles

of the brain. In each a group of small simple serous cysts is
seen forming a growth, the size and shape of an ordinary white
grape.

From a native male, aged 60, who died from remittent fever.

90. Cystic degeneration of the choroid plexuses of both lateral ven-
tricles of the brain. Found on post-mortem examination of a
native male, aged about 45, who was brought to the hospital in
a moribund condition, and died (within ten hours of admission)
from serous apoplexy. The kidneys were contracted and
granular.

91. The cerebellum, medulla, and upper part of the spinal cord of a

“ Waler ” mare. The animal died from general paralysis of four
months’ duration. A distinctly circumscribed button -like
thickening of the membranes of the cord, with partially
organised inflammatory effusion between them and the posterior
columns, may be observed about an inch below the medulla.

All the membranes of the bruin were intensely congested and dark, especially at
the base, and on the inferior aspects of both lateral lobes of the cerebellum.
Each lateral ventricle contained some thick, yellowish lymph, larger in
quantity in the right than in the left. The tliird and fourth ventricles
were filled with the same material, only more purulent-looking. The
lining membrane of all the ventricles was vividly injected and vascular. A
large quantity of reddish turbid serum was accumulated between the pia
mater and the middle cerebral lobes at the base of the brain.

92.

93.

94.

95.

Portions of dura mater covering the inferior surfaces of each
lateral lobe of the cerebellum in the above case. A development
of rounded, pea-like, bony growths is seen, from the under surface
of this membrane. The inner aspect of the calvarium was
smooth and normal in appearance opposite these growths, so
that they seem to be genuine pathological products — true osteo-
phytic developments from the dura mater itself. ( Presented by
S. Hart, Esq., m.r.c.y.s., Calcutta.)

“ Laceration and division of the spinal cord and membranes, about
three inches belovv the medulla oblongata, the consequence of
fracture of the fifth cervical vertebra.” (Ewart.) (Presented
by Dr. T. W. Wilson.)

llie cervical portion of the spinal cord and its membranes from a
case of dislocation at the third intervertebral articulation. ( See
prep. No. 48, Series I.) The man, a coolie, aged 25, became
almost immediately paralysed (both upper and lower extre-
mities, &c.), but survived the accident for about twelve
^days.

The upper portion of the spinal cord showing laceration and soften-
ing, the results of fracture of the fourth and fifth cervical
vertebrae. From a native female, Kamini, aged 50, who fell out
of an upper window while in a drunken condition. She was
brought to the hospital in a completely paralysed condition

268

LACERATION AND SOFTENING. [series viii.

and very prostrated, but survived the injury for twelve hours.
( Presened by Professor J. Fayrer.)

96. A preparation exhibiting laceration, amounting to almost complete

severing of the spinal cord in the cervical region, corresponding
to the site of a fracture of the fifth and sixth cervical vertebrae.

The patient, a European seaman, aged 25, while semi-intoxicated,
jumped off one of the jetties into the river (a height of about
1-1 feet), at a spot where the water was only about two feet
deep. On admission into hospital there was complete paralysis of
the lower extremities and trunk, but not of the upper extremities,
lie lived for 44 1 hours. ( See further, prep. No. 45, Series I.)

97. The spinal cord and membranes of a native male, aged 40,

showing much compression and laceration in the lower dorsal
region, the result of a comminuted fracture of the eleventh dorsal
vertebra. There was no external wound or mark of injury.
( See further, prep. No. 51, Series I.)

98. “ Softening of the spinal cord in the lumbar region. The cavity

at the centre of the softened portion was originally occupied by
an apoplectic clot. The patient, a Hindu, aged 45, fell down
a staircase twelve feet high, was admitted with paraplegia and
retention of urine, and died 28 hours after admission. There
was no fracture of the vertebrae.” (Colies.)

The softening of the cord is very distinct, but all traces of blood-
extravasation have now disappeared.

99. Spinal cord of a patient who died paraplegic on the 28th

February 1863. “The patient, a Maltese, aged 40, was
admitted for chancre into the hospital on the 28th of
December 1862. On 3rd February 1863, after a severe febrile
attack, attended with extreme prostration, his lower extre-
mities, and the trunk as high up as the level of the nipples,
became paralyzed. There was paralysis both of sensation and
motion, which continued to the day of his decease. For
the last few days of his life he suffered from low fever and
delirium. The cord in the lower part of the cervical and upper
part of the dorsal regions was found extensively softened.
Drain, thoracic, and abdominal viscera healthy.” (Ewart.)
( Presented by Professor S. B. Partridge.)

100. “ Preparation showing softening and destruction of the cord at
the commencement of the cauda equina.” (Ewart.) No
history.

101. “ Spinal cord of A. C., an Englishman, admitted into hospital
on the 30th of October 1866 with stricture and pain in the
lumbar region. The pain increased, he became paraplegic, and
died on the 13th November 1866.

A portion of the cord, about the size of a sixpence, in the lower dorsal
region, is softened and diffluent.” (Colles.) The last dorsal
and first lumbar vertebrae were found carious. ( See prep.

No. 21, Series Y.)

102. “A portion of the spinal cord which was much congested in the
situation of the cauda equina. There was a large quantity

SEBIES VIII.]

SPINAL MENINGITIS.

269

of cerebro-spinal fluid. From a Norwegian, aged 42, who
suffered from partial paraplegia brought on by pumping in a
water-logged vessel at sea, when he was obliged, for long periods,
to stand up to his knees in water. He retained partial use of his
limbs, the left being the most paralyzed of the two. It was
accompanied by great diuresis. He could control the action of
the sphincter and the bladder. He had, whilst in hospital, two
attacks of dysentery. During the second attack he was carried
off by cholera.” (Ewart.) (Presented by Professor J. Fayrer.)

103- Spinal cord and membranes from a case of acute cerebro-spinal
meningitis,— a native male, aged 27.

The dura mater was stained pink, but its structure healthy. Between
it and the other membranes of the cord considerable serous
effusion was found, especially in the lumbar region. Both
arachnoid and pia mater are opaque from recent inflammatory
exudation (lymph). This condition is slightly marked in the
cervical region, but well pronounced along the whole of the rest
of the cord. The substance of the latter is softened in the
lower dorsal region, but in the lumbar cut unusually firmly. The
grey and white matter appeared to be throughout preternaturally
vascular, but not otherwise altered.

104. Spinal cord (dura mater removed) from a case of acute cerebro-
spinal meningitis, — a native male, aged 30. Both the arach-
noid and pia mater are seen greatly thickened and opaque from
the presence of a copious exudation of recent lymph, which covers
both surfaces of the cord (itself healthy), and descended from
the medulla and brain. ( See prep. No. 54.)

105- Preparation showing an amputation at the upper third of the
right leg, in which the ends of the tibia and fibula, especially
the latter, are rough, jagged, and denuded of periosteum. A
branch of the' internal popliteal nerve can be traced into
immediate contact with the sharp fibular extremity. The
patient, a native male, aged 24, died from tetanus on the
thirteenth day after the operation, and on the fifth day from the
commencement of the tetanic symptoms. It is believed that the
latter were attributable to the irritation of the large nerve trunk
above noted, by the roughened portion of the fibula in the stump.
( See further, “ Surgical Post-mortem Records,” vol. I, 1879,
pp. 547-48.)

106 A portion of the great sciatic nerve showing acute inflam-
mation of the sheath. The nerve itself is a little softened, but
not otherwise materially affected. This condition was found
associated wdth erysipelatous inflammation of the left thigh, and
incipient softening and suppuration of the muscles on both
anterior and posterior aspects. During life the patient, a native
male, aged 30, complained of very severe pain along the whole
course of this nerve. (See further, “ Surgical Post-mortem
Records,” vol. I, 1880, pp. 703-4.)

107 Preparation showing bulbous enlargement of the nerve ends in a
stump, about two inches below the elbow-joint. The median
nerve is especially swollen and enlarged at its extremity, and

270

DISEASES OF THE NERVES.

[SEBIES VIII.

surrounded by much dense fibro-cellular tissue. The patient
suffered so much pain that a secondary amputation at the lower
third of the arm had to be performed. ( Presented by Professor
E. Goodeve.)

108. Ring-finger of the left hand of a Negro, amputated through the
middle of the metacarpal bone. The first phalanx had been
removed nine months previously on account of an injury. So
painful was the stump on the slightest pressure, that it rendered
the hand useless for work, and the present amputation was there-
fore performed. On dissection, a digital branch of the median
nerve supplying the outer and anterior aspects of the stump is
found much enlarged, and terminating in a slight bulbar expan-
sion opposite the first phalangeal articulation, to which, and to
the palmar aspect of the base of the second phalanx, it is firmly
bound down by bands of fibrous tissue. No nerve filaments can
be traced beyond this point. On the inner side a small digital
branch from the ulnar nerve is traced, without any appreciable
enlargement, as far as the first phalangeal articulation, where it
also is lost. The end of the stump is formed by the cartilagin-
ous head of the second phalanx, covered by thickened integu-
ment. There is fibrous ankylosis of the two phalanges.

109. A dissection of an old amputation stump of the left leg (lower
third), to exhibit the enlarged bulbar terminations of the anterior
and posterior tibial nerves, surrounded by dense fibrous and fatty
tissue. The bones are rounded off and smooth.

The amputation was performed, three years previously, for gangrenous
ulceration of the left foot and ankle. — From a native male,
aged 40.

110. Portions of the right and left ulnar and median nerves from a
case of tubercular and ansesthetic (“ mixed”) leprosy, — an East
Indian male, aged 25, who died in hospital from acute pulmonary
tuberculosis. These nerves show very characteristic enlarge-
ment, thickening, and induration. Almost all the cutaneous
nerves in both the upper and lower extremities were similarly
affected. The disease had existed for several years.

111. Specific enlargement of the peripheral nerves in leprosy. The
preparation exhibits various nerves, e.y., the medians, radial s and
ulnars from the upper extremities, and the long saphenous and
musculo-cutaneous from the lower extremities of a young man
(aged twenty), of pure European parentage, who had suffered
from the disease for about ten years, and who died in hospital
while undergoing treatment by “gurjan oil.” All these
nerves are enlarged to twice or three times their normal size.
They are firm and rigid, and their external fibrous sheaths
(neurilemma) remarkably thickened and dense.

Microscopical sections show the nerve fibres surrounded and compressed by
nucleated connective tissue, which forms (as seen in the transverse
section of a nerve) radiating bands, starting from the thickened neuri-
lemma, and passing between the fibrill® of which the nerve is composed,
isolating them. The latter are atrophied and shrunken. The white
substance of Schwann broken up into a granular or molecular pulp,
giving, in longitudinal sections, a remarkably beaded appearance to the

series viii.] ENLARGEMENT OF NERVES IN LEPROSY. 271

nerve-filament. In parts it was found to have quite disappeared, the axis-
cylinder alone remaining ; and, lastly, even the latter is absent in some of
the spaces mapped out by the connective tissue dissepiments above described;
nothing but a granular oily debris occupying the place of the disorganised
nerve-tubule. The thickening, induration, and enlargement of these
nerves are all, therefore, due to an exaggerated connective tissue growth
(hyperplasia) of the neurilemma and inter-fibrillar septa, with con-
temporaneous atrophy, degeneration, and gradual disappearance of the
proper nerve structure.

112. A small fibroma developed in connection with the left radial
nerve, and found situated on the outer side of the wrist-joint
of a native lad, aged about sixteen. The growth is the size
and shape of a shelled almond, of pearly-white colour at the
surface, more opaque-looking on section. It is invested by a
delicate capsule, formed by an expansion of the neurilemma of
the nerve. The main portion of the trunk of the latter lies
to one side (below) the growth, only a few nervous filaments
can be traced into its proper substance, and these chiefly towards
the periphery. The little tumour itself consists of very abund-
antly nucleated white fibrous tissue, with a few elastic fila-
ments, and here and there a capillary vessel. It is, therefore, a
fibroma, not a true neuroma.

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PAET V.

INJURIES AND DISEASES OF THE TONGUE,
TONSILS, PHARYNX, (ESOPHAGUS,
STOMACH, INTESTINES, PERITONEUM,
LIVER AND PANCREAS, &c.

Seuies IX.

SERIES IX.]

INDEX.

275

Series IX.

INJURIES AND DISEASES OF THE TONGUE,
TONSILS, PHARYNX, (ESOPHAGUS,
STOMACH, INTESTINES, PERITONEUM,
LIVER AND PANCREAS, &c.

INDEX TO THE SERIES.

A— THE TONGUE—

1 — FOLLICULAR ENLARGEMENT IN CHOLERA, 1, 2, 3, 4, 5, 6.

2, IN HYDROPHOBIA, 7, 18.

3— Gangrene, 8.

4— Carcinoma, 9, 10.

B. -THE TONSILS—

1.— Ulceration, 11.

C. - FAUCES, PHARYNX, AND CESOPIIAGUS—

1. — Foreign body removed from, 12.

2. — Perforation by a pigeon-bone, 13.

3. — Sloughing of mucous membrane, 14

4. — Abscess, 15.

5. — Stricture, 16, 17.

6. — Effects of hydrophobia, 18.

7. — Morbid growths or deposits :

(a) Diphtheritic, 11.

(b) Carcinomatous, 16.

D. -THE STOMACH -

1. — Gunshot injury, 19.

2. — Effects of irritant poisons :

(a) Arsenic, 20, 21, 22, 23, 24.

( b) Sulphuric acid, 25, 26.

276

INDEX.

[series IX.

3. — Thickening of the walls : —

(a) General, 28, 29. 30, 31, 32, 33.

( b ) Limited (fibroid), 34, 35.

4. — Thinning of the walls, 36, 37.

5. — Ulceration, 30, 38, 39, 40, 41, 42, 43,* * 44,* 47-

6. — Perforation, 22, 36, 38, 39, 41, 45, 46, 47.

7. — Carcinoma :

(а) Scirrhns, 46 (?), 48, 49, 50.

(б) Epithelioma, 51, 52, 53.

8. — Preparations from the lower animals, 54, 55, 56.

E.-THE INTESTINES—

1. — Effects of external force, 57, 58, 59, 60, 61, 62, 197.

2. poisons, 63 (?), 64.

3. — Blood Extravasation, 62.

4. — Inflammatory thickening, 65.

5. —Amyloid degeneration, 66, 67, 68.

6. — Follicular enlargement (irritation) in cholera, 69, 70, 71,

72, 73.

7 . — Ulceration : —

(<f) Simple, 74, 75, 76.

(6) Tubercular, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86.

101, 102, 103, 104, 105.

(d) Dysenteric : —

a. — Acute catarrhal, 106, 107, 108, 109, 110, 111.

(3 — Acute catarrho- fibrinous or sloughing, 112, 113, 114, 115,
116, 117, 118, 119, 120, 121.

7. — Acute fibrinous, 122, 123, 124, 125, 126, 127, 128.

a a a h h h h a h li

8. — Chronic, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138,

h a h h h

139, 140, 141, 142, 143.

e. — Healing or healed ulcers (repair after dysentery), 111,
132, 138, 141, 142, 143.

8. — Perforation : —

(a) Of small intestine, 75, 99, 144, 145, 146, 147.
(£) Of large intestine, 113, 148, 170, 203.

a . With atrophy or thinning of the coats of the bowel.
h. With hypertrophy or thickening of the coats of the bowel.

* Tubercular.

H-*

SERIES IX.]

INDEX.

277

9 —Gangrene and Sloughs, 115, 133, 153.154. 155, 156,157, 158,
159, 160, 161, 162, 163, 164, 194, 195, 196.

10. — Intussusception, 165, 166, 167, 168, 169, 170, 171, 172, 173.

11. — Internal strangulation, 174, 175, 176, 177, 178, 179, 180, 181,

182.

12.— Hernia : —

(a) Inguinal, 183, 184, 185,186, 187,188, 189,* 190* 191 * 192,+

193,+ 194, § 195§, 196§.

(b) Ventral, 197, 198.

(tl) Results of operation for radical cure of, 200, 201 .

13. — Stricture, 202, 203, 204.

/ » r > | r ,

14. — Artificial anus, 195, 196, 205, 206. ‘

15. — Hemorrhoids, 207, 208, 209. /'**'

16. — Prolapsus recti, 210, 211, 212. \V-

\ C

17. — Moreid growths, 169, 213, 214, 215, 216, 217.

18. — Malformations:—

(a) Diverticula, 218, 219, 220, 221. 222, 223, 224.

(b) Abnormal vermiform appendix, 225.

(e) Imperforate anus, 226, 227, 228, 229, 230.

19.— Entozoa ( See Series XX).

20. — Preparations from the
236, 237.

lower animals, 231,

232, 233, 234, 235,

F.— PERITONEUM, OMENTUM, AND MESENTERY.

1— Effects of external force, 238.

2 Thickening and opacitt, 198, 239.

3.- Enlargement and tumefaction of mesenteric glands

(?) In typhoid or enteric fever, 99, 100, 240, 241, 242 243
(&) In cholera, 244.

4.— Morbid growths and deposits : —

(«) Tubercular, 245, 246, 247, 248, 249, 250,
255, 256, 257.

(1) Lymphomatous, 258, 259, 260.

(0 Calcareous, 257, 261.

(d) Carcinomatous, 262.

251, 252, 253, 254,

—LIVER.

1— Rupture, 263, 264.

2. Effects of pressure, 265.

* “Infantile.”

t “Congenital.”

§ Strangulated.

278

INDEX.

[series IX.

3. — Blood extravasation, 2G6, 267.

4. — Cirrhosis, 268, 269, 270, 271, 272, 273, 2/4, 275, 2/6, 2//.
g. — Syphilitic hepatitis, 278, 279, 280, 281, 282, 283, 284, 285
6. — Abscess :

(a) Single or solitary, 286, 287, 288,* 289*, 290,* 291, 292,* 293,*
9q4, 005 * 296/ * 297, 298, 299.

{h) Multiple and pysemic, 300 301, 302, 303, 304, 30o, 306.

7.— Hepatitis pigmentata

$ 318, 319, 320.

8. — Morbid growths and infiltrations

(a) Fatty, 321, 322, 323, 324 325.

(5) Amyloid or albuminoid, 2h3, 3 uo, Sub, Su/, ou&.
(c) Lymphomatous, 3-9, 330.

(tZ) Tubercular, 331, 332.

(e) Carcinomatous, f 333, 334, 335, 336, 337, 338, 3o9, 340,

e m .

341, 342.

( f) Sarcomatous, 343
( q ) Cystic, 344, 345, 346, 347.

s s

9.— Entozoa£—

la) Hydatids (echinococci), 348, 349, 350, 351.

(6) Distomata, 352, 353, 354, 355, 356.

10 —Malformations, 357, 358.

H. -BILE-DUCTS AND GALL-BLADDER—

1 . _BILE-DUCTS, OBSTRUCTION OF, 359, 360, 361.

2. — Dilatation of, 369, 370.

3 Occupied by round worms (lumbrici), 362, 363

4. -Gall bladder, rupture from external violence, 364.

5. — Atrophy, 365.

e —Dilatation of, 269, 360, 366, 367, 368.

y.-Occcr™ nv calcul,, 367, 369, 370, 371, 372, 373, 374, 375.

8. — Ulceration from calculi, 376.

9. — Calcareous infiltration of walls, 375.

J— PANCREAS —

1— Carcinoma, 377,378,379.

9 Haemorrhagic infarction (apoplexy), 380.

H dilatation of pancreatic duct by calculi, 381

3.— Obstruction and dilauhui _

% See also series XX.

SEBIES IX.]

DISEASES OF THE TONGUE.

270

1, The tongue from a case of cholera, — a native male, aged 40, who died
in the stage of collapse, — illustrating a very commonly observed
j postmortem appearance — viz., great enlargement and promin-
ence of the circumvallatse papillae and mucous follicles at the
base of the organ, and also of those of the pharynx. Many
of tlie hypertrophied lingual glands show pitted surfaces.

2 Great hypertrophy of the circumvallate papillae and mucous follicles
at the base of the tongue, — from a case of cholera.

The same change, though to a less marked degree, is observed in the
mucous membrane of the pharynx and oesophagus, with also,
superficial shredding of epithelium in patches in the latter.

i 3. A similar specimen. The mucous follicles and glands stand out
prominently. This condition seems attributable to two causes, —
(1) tbe shrinking of the surrounding tissues, as of the tissues
of the body generally, from deprivation of their moisture to add
to the cholera flux ; and (2) to excessive stimulation of tbe
glandular structures of the entire alimentary canal, and their
consequent temporary hypertrophy or enlargement.

I In this case — as in almost all others of like nature — the oesophageal
and peptic glands, the mucous follicles and patches of Peyer of
the small intestine, and the solitary glands of the large intestine,
were all similarly affected.

4. Enlargement and prominence of the glands at the base of the

tongue, notably of the circumvallatse papillae and mucous follicles
of the tonsils and pharynx. — From an East Indian boy, aged
seven years, who died of cholera.

The patient was brought to the hospital about twelve hours from the commencement
of the attack, in quite a collapsed condition. Reaction set in in about
another twelve hours, but the urinary secretion was never established, and
he died with symptoms of urannia (convulsions, &c.,) within forty-eight hours
of admission.

5. Tongue showing a swollen and prominent condition of the papillse at

its base, from a case of cholera, a native male patient, aged 45.

6. An enlarged, prominent, and swollen condition of the circumvallatse

papillse at the base of the tongue, and of the mucous follicles
of the pharynx and tonsils, &c., in a case of cholera, — a Eu-
ropean seaman, aged 20, who died collapsed five and a half hours
after admission into hospital.

7. The tongue, fauces, and larynx of a native male, aged 25, who died

from hydrophobia. In the recent state there was livid . con-
gestion of the mucous membrane and abnormal enlargement and
vascularity of the papillary and follicular structures. — {See also
prep. No. 18.)

1 Ihc hydrophobic symptoms were developed five weeks after the man bad
been bitten by a rabid bitch. (“ Medical Post-mortem Records ”
vol. I, 1870, pp. 995-90.)

8. Gangrene of the tongue. About half an inch of the anterior

portion (apex) of the tongue has completely mortified. It is of
very dark colour, and almost separated from the rest of the
organ, — only a few shreds of sloughy tissue serving still to

280

CANCER OF THE TONGUE.

[series IX.

connect the two. The line of demarcation between the gangren-
ous and healthy structures is very distinct and abrupt. Ihe
lower jaw is rough, denuded of periosteum, and superficially
necrosed. No history. ( Presented by Professor J. Fayrer.)

9. A preparation showing a very rapidly-growing epithelioma ol the
right side of the tongue, which, with the corresponding hall ol
the lower jaw, was removed by operation. The jaw was bisected
at the symphysis, and sawn through again a little above the
angle on the right side. The tongue was divided by a wne-

The patient) a native male, aged 45, stated that the growth was of only
six weeks’ duration, and had commenced as a painful pimple on
the under surface of the right border of the tongue. The man
was fairly healthy looking. He was not a tobacco-smohei.
the teeth of the lower jaw were firm and quite free from decay.
There was no hereditary history. “ The lymphatic glands below
the jaw were slightly enlarged.” He died thirty-six hours after
the operation from pneumonia. At the post mortem examination
the left half of the jaw was excised, and is now united to the
right and exhibited in the preparation. The growth presents
the form of a shallow oval-shaped ulcer, about an inch m length
and half an inch in breadth, situated on the lateral and mfeno
border of the right half of the tongue, opposite the first and
second molar and second bicuspid teeth. The edges are haul,
the base soft and shreddy. The papillae, mucous membrane, and
submucous fibro-clastic tissue are all m°re °r leBS^stecjcd
over the whole ulcer, so that the muscular tissue ol the oiDan
is freely exposed and partially disintegrated.

Under the microscope sections exhibit an epithelial, rapidly-progressive growth.

The sZSal portions show a truly epithelial structure, -large, faintly
granular, mono-nucleated cells being heaped together in consxderab e nia-ses,
Sd dipping also into the deeper tissues. Numerous “ nests ’or globe » are
also visible^ The deeper layers of the sections made exhibit a snial -ee_.lt
growth infiltrating freely the submucous and muscular tissues. and tarn „
to their gradual disintegration or removal. Ihe left halt ol the bis « "
tongue is nuite free from infiltration or morbid growth ; hut the muscular
tissue is everywhere found very highly fatty (metamorphosed). ( Presented

hy Professor K. McLeod.)

10. Epithelioma of the tongue. The base and a

of the left half of the organ are seen to be destioyed by a

sx sew

tonsil arc all infiltrated. The subject was a European (male)’
aired 50 The disease had advanced too far for any operative in -

Scot The man’s health was greatly shattered, and the spec Sc
cachexia well marked. The cancer commenced as a sma

SERIES IX.]

DIPHTHERITIC TONSILLITIS.

281

pimple on the side of the tongue eighteen months prior to his
admission into hospital. There was much difficulty in deglu-
tition, and repeated haemorrhages occurred from the ulcerated
surface. Both these circumstances told upon the patient’s
condition, and he died exhausted and worn out by the disease.
(Nee further, “ Surgical Post-mortem Records,” vol. I, 1875, pp.
195-96.)

11. “ Preparation showing the pharynx, larynx, and trachea of a

European child, aged nearly live years. Yellowish coloured
diphtheritic deposit or false membrane is very clearly exhibited
in the pharynx. An ulcerated surface is also exposed behind
the left tonsil. The existence of croupy deposit is observed in
the superior region of the larynx.” (Ewart.) The remains of
the deposit over both surfaces of the soft palate and around the
rima glottidis • may still be easily distinguished, as also the
ulcerated and excavated condition of both tonsils, but the rest of
the membranous exudation referred to is no longer visible.
( Presented by Dr. W. Martin.)

12. A fish-bone, nearly two inches in length, and with very sharp-

pointed extremities, removed from the lower part of the oesoph-
agus of a lady. A probang having been passed beyond the point
where the bone was ascertained to be lodged, the latter became
fixed in the sponge of the instrument, and was thus successfully
withdrawn. ( Presented by Dr. J. Ewart.)

13. “ Perforation of the oesophagus and aorta, caused by a fragment of

pigeon-bone.” The perforation of the oesophagus is situated
a little to the left of the median line, and the aorta has been
penetrated at the descending portion of the arch, just a little
below the origin of the left subclavian artery. A blue glass rod
indicates the direction taken by the piece of bone, which is also
attached to the preparation by a thread, near this spot. The
fragment of bone is about an inch and a half in length, about
the thickness of a knitting-needle, and very sharp and pointed at
one extremity. ( Presented by Surgeon J. O’Brien, 43rd
A. L. I., Gowhatty, Assam.)

14. The trachea and oesophagus of a native boy, aged twelve years,

who died from cancrum oris and dysentery. The lower lip, for
about an inch on either side of the median line, was sloughy and
disorganised, and the bone below it bare, rough, and destitute of
periosteum.

In the upper part of the oesophagus the mucous membrane and sub-
mucous tissues show circumscribed sloughing over a space about
two inches in length and half an inch in breadth. This con-
dition extends into the adjacent portion of the trachea, exposing
the cartilagenous rings, and producing softening and superficial
ulceration of the mucous membrane for about an inch. ( See
further, “ Medical Post-mortem Records,” vol. Ill, 1880, pp.
553-54.)

15. The larynx, pharynx, and a portion of the trachea showing (1)

the opening made by the operation of laryngotomy, necessitated
on account of impending suffocation due to (2) a large

282

DISEASES OF THE CESOPHAGUS.

[SEBIES IX.

abscess, with thick offensive purulent contents, situated in the
right wall of the pharynx, between it and the larynx, pressing
upon, and thus greatly obstructing or narrowing the rima
glottidis ; (3) slight superficial ulceration of the mucous mem-
brane on the under surface of the epiglottis, and over two or
three of the upper rings of the trachea ; the latter produced by
the pressure of the metallic tracheotomy-tube employed in this
case. The patient, a native male, aged about 40, died from
exhaustion and lobular pneumonia three weeks after the
operation.

16. “ The tongue, pharynx, upper two-thirds of the oesophagus,

epiglottis, larynx, and trachea, as far as the bifurcation. The
oesophagus and pharynx are opened from behind, exposing, in
the lower part of the tube, nodules of cancerous material
beneath its mucous membrane. Higher up, and including the
pharynx, the cancerous substance has undergone degeneration,
softening, and ulceration, leading to the destruction of a portion
of the mucous membrane, muscular structure, and the soft parts
interposed between it and the larynx which, at this point, has
been all but perforated. The trachea and larynx have been
opened along the anterior aspect, illustrating malignant ulcer-
ation of the left vocal cords, and several nodules of medullary
matter deposited beneath the mucous membrane of the lower
part of the larynx.”

“ On miscroscopical examination, large cancer cells, more or less filled with granular
and fatty matter, caudate and endogenous cells were discovered both iu
the oesophageal and laryngeal nodules. The cervical and bronchial glands
were much enlarged by strumous and black pigmentary infiltration.”
(Ewart.)

“ The patient, Thomas Phillip, Portuguese, aged 57, could not swallow
for some days prior to death. Neither could a tube be passed,
owing to oesophageal obstruction ; moreover, his respiration was
so seriously embarrassed, that tracheotomy was performed.
He sank from asthenia eleven days after the operation.”
( Presented by Professor J. Fayrer.)

17. “ Stricture of the oesophagus, apparently due to muscular spasm.

The patient died after a prolonged illness.”

There was no history of any injury (as from corrosive poisoning,
&c.,) and the lining membrane as well as the muscular and
other tissues of the oesophagus present nothing abnormal.
( Presented by Surgeon J. O’Brien, 43rd A. L. I., Gowhatty,
Assam.)

18. The tongue, fauces, pharynx, oesophagus, and larynx of a native

male, aged 34, who died from hydrophobia.

The papillae of the tongue are enlarged and prominent, and, in the
recent state, were greatly injected and vascular, especially those
at the posterior and back part of the organ. There is longi-
tudinal stripping of the mucous membrane of the oesoph-
agus, particularly at its lower end, and much denudation of
epithelium. In the larynx (when fresh) there was noticed

SERIES IX.]

DISEASES OF THE STOMACH.

283

considerable thickening and vascularity of the epiglottis, with
some oedema of its upper and lower surfaces and margins.

Nothing specifically pathological was found in any of the other organs of the body
in this case, except that the membranes of the brain and both lungs
were abnormally dark, and loaded with fluid venous-looking blood. (See
further, “ Surgical Post-mortem Records,” vol. I. 1873, p. 28.)

19. “A stomach, in which there is an oval bullet-opening, admitting

the forefinger, and a smaller one into which a pencil can be
barely introduced. There is also shown a traumatic aueurismal
sac, about as large as a pigeon’s egg, communicating with one
of the branches of the pancreatic artery. The patient was a
sepoy stationed at Rawul Pindee. He died from haematemesis,
the haemorrhage having flowed from the ruptured sac, through
the small opening, into the cavity of the stomach.” (Ewart)

( Presented by Dr. J. Fairweather.)

20. A stomach which has been turned inside out to show the effects
of a corrosive poison upon the mucous lining of the or^an.
The latter, over almost the whole of the oesophageal half, 'and
especially along the greater curvature, is seen superficially eroded
and even ulcerated, with much puckering and corrugation of
the mucous coat. Near the pylorus there is a stilf adherent
small dark slough. — From a case of arsenical poisoning.

21. “A stomach inflamed from the swallowing of yellow arsenic.

The mucous membrane is much puckered and raised into ridges.”
(Ewart.) A sharply defined, oval-shaped perforation, sufficiently
large to admit a goose-quill, is seen to have taken place through
the posterior wall, near the lesser curvature, and about two inches
from the oesophageal opening.

22.

!23.

Stomach showing the effects of poisoning by arsenious acid.
I he whole mucous membrane is highly inflamed, much corru-
gated and thickened. Much inflammatory effusion (lymph) has
taken place along the greater curvature and around the pylorus
so that the surface here, in addition to its eroded and ulcerated
condition, presents a rough, granular and thickened appearance
and adjacent ridges of the mucous membrane are partially
united and matted together by the same material.

A portion of the stomach from a case of arsenical poisoning.
No ulceration has occurred, but, in the recent state, there was
intense, livid congestion, and much softening of the mucous coat
and the peptic glands and mucous follicles generally were
hypertrophied, prominent, and irritable looking. The latter
condition may still be observed.

iThe heart was examined, but no injection or ecchymosis of the endocar
Surgeon1)6 dlscovered- {Presented by Dr. C. O. YVoodfoi

lining

Police

44. The stomach of a young native female, supposed to have died
from flrh<Ba/ Ifc c4lblts markcd signs of acute inflammation

llt JZ *TT?\ 1 The Surfacc of th0 stomach, in the
te> was of a bright vermilion colour— in parts almost

284

ACUTE GASTRITIS.

[SEEIEB IX.

purple. The whole of the mucous membrane is much softened,
especially along the lesser curvature, and at the pylorus. In
these situations it is shreddy, flocculent, partially detached,
hangs in soft woolly masses. No ulceration or extensive sloughing
or perforation has taken place. An immense number of minute
golden-yellow metallic particles (sulphide of arsenic) are scattered
diffusely over the whole inflamed surface. The contents of the
stomach consisted of dark, grumous, and sanguinolent fluid, with
a large quantity of undissolved arsenic.

The duodenum presented similar appearances, but not to so marked a degree, and i
evidences of acute irritation extended a considerable distance into the rest of
the small intestine. There was much shredding of the mucous membrane of
the oesophagus, in the form of delicate, longitudinal, fringe-like, detached
fragments, and deep-purple injection of the submucous tissues. There was
very marked sub-endocardial ecchymosis of the left ventricle of the heart, most
intense along the septum ventriculorum and papillary muscles, ( Presented
by Professor C. 0. Woodford.)

25. A portion of the oesophagus, the stomach, and the duodenum of a

native female, aged 15 years, who, on the 8th of May 1874,
swallowed a small quantity — accordingly to her own statement
a teaspoonful — of strong sulphuric acid for the cure of enlarge-
ment of the spleen, from which she was suffering. The patient
died in hospital from inanition and asthenia on the 28th of June
(seven weeks and two days after). There is nothing remarkable
in the condition of the oesophagus. The mucous membrane of the
stomach is everywhere much thinned, and in parts discoloured,
presenting a dark-slate or greyish appearance ; in others, — especially
along the lesser curvature and pyloric half of the organ, — dark
purple.* Stretching from the oesophageal opening to the pylorus
(along the upper curvature), there is seen, very distinctly, an
almost completely cicatrised, elongated, irregular-shaped ulcer,
about 3^ inches in length and 2 inches in breadth (at its
widest part). Numerous radiating processes pass outwards in
all directions from this ulcer into the surrounding mucous mem-
brane. The reparative material consists of lowly-formed (im-
mature) connective tissue. The duodenum was found deeply bile-
stained, and coated with a thick layer of dark-greenish mucus,
but no loss of tissue appears to have taken place.

26. The stomach and duodenum of a young native female, who had

taken strong sulphuric acid as*a remedy for “ spleen.” She was
treated in hospital for two months and six days ; gradually
became weaker and emaciated from inability to retain and digest
food, and died at last somewhat suddenly. There was constant
aching pain at the epigastrium.

The mucous membrane of the stomach and duodenum is covered with
numerous small superficial ulcers, of a more or less rounded
outline. At the pylorus there is much cicatricial contraction
with thickening of the muscular coat, so that a strictured

* Much of this discolouration has been lost since maceration of the stomach in spirit.

SERIES IX.J

CHRONIC GASTRITIS.

285

27.

28.

29.

30.

31.

condition of this orifice has taken place, and barely admits
now a crow-quill. In the preparation a glass-rod, the exact
size of the contracted orifice, has been passed through it.

The stomach of an aged East Indian woman who died from acci-
dental carbolic acid poisoning. There was a strong odour of the
acid on opening the stomach ; the mucous membrane was
throughout moderately congested, and much softened. In parts
it presented a superficially abraided or eroded condition, which
can still be seen in the preparation, but there is no actual
ulceration.

“ An excellent illustration of the effects of chronic gastritis. All
the coats of the stomach are thickened. But the mucous mem-
brane is enormously increased in diameter, and arranged in
longitudinal folds, some of which project half an inch from the
general level of the internal surface of the organ.” (Ewart.)
No history.

“ Chronic gastritis, occurring in a habitual drunkard (European).
There is thickening of the mucous membrane, which is arranged
in longitudinal folds, many of which are a line and a half in
height. These appearances are most marked along the greater
curvature. The .peritoneal tunic is thickened and opaque.”
(Ewart.) There appears to be also a good deal of recent inflam-
matory effusion over the surface of the mucous membrane, for
about two inches around the pyloric orifice.

The pyloric half of the stomach showing great thickening, rigidity
and corrugation of the mucous membrane, the results of chronic
gastritis. Around the pyloric opening itself there are three
or four shallow superficial ulcers, of oval or rounded shape ;
the largest, the size of a four-anna piece (sixpence), the smallest'
of a split-pea. They have abruptly-defined sharp edges, and
expose the sub-mucous tissue. ( Presented by Professor °Edward
Goodeve.)

General hypertrophy of the walls of the stomach, from a case of
morbus Brightii. The patient, a Hindu male, aged GO, had
long suffered from symptoms of chronic gastritis. ^The hyper-
trophy involves all the coats, but particularly the submucous and
muscular ; in parts, their combined thickness measures fully a
third of an inch. Scattered irregularly over the mucous surface
are a few shallow superficial ulcers.

32. The stomach of a “ native female patient, admitted into the
Howrah hospital with symptoms of cholera— a dejected face •
tenderness in the epigastrium ; vomiting of mucus and bile
but no blood ; pulse wreak and small ; stools formed. No
history or evidences of irritant poisoning.”

The mucous membrane of the stomach is thrown into huge, thick
folds ; the organ altogether much contracted. In the sulci
between the folds, and partly smeared over them, is a good deal
of inspissated, shreddy-looking mucus. The appearances are
those of acute gastritis ( Presented by Assistant Surgeon Gopal
Chunder Roy, Howrah.) ° 1

286

CHRONIC GASTRITIS.

[SERIES IX.

33. Acute gastritis (catarrhal). The mucous membrane of the

whole of the stomach shows intense vascularity, ecchymosis, and
oedema ; and is almost uniformly covered with soft, granular,
recent exudation material, in parts also is superficially eroded.
There was no history or evidence of any kind of irritant
poisoning.

From a native female, aged about 25, admitted into the hospital in the
last month of pregnancy, with severe hjematemesis and great
prostration. She died an hour after admission. ( Presented hu
Professor T. E. Charles.)

34. The pyloric end of the stomach of a native male patient who

suffered from “ constant vomiting after food, constipated
bowels, hiccough and drowsiness.”

The pylorus and about three inches of the mucous membrane of the
stomach above it are greatly thickened, and very hard and
firm. All the coats of the stomach are here hypertrophied,
and the channel, in consequence, so narrowed that a director
can barely pass through it. The mucous membrane is thick,
soft, covered with minute villous-like tufts (as seen under the
microscope). The suh-mucous tissues are also greatly hyper-
trophied, the smooth muscular fibre being highly developed (hyper-
plasic), and the fibro-elastic tissue exaggerated. The glandular
structures are compressed and atrophied, their lining epithelium
highly infiltrated with fat.

No abnornal cell elements can anywhere be detected, even after the most careful
examination. The condition seems to be that of purely fibroid thickening
of the pylorus ; and, although the parts are firm and very scirrhus-like,
there is no evidence of stroma, cancer. cell, &c. The rest of the stomach,
including its oesophageal end (not preserved), exhibited great thinning
and attenuation of the gastric walls, probably from constant over-distension
owing to the obstruction at the pylorus. ( Presented by Assistant Surgeon
Gopal Chunder Roy, Howrah.)

35. The cardiac half of the stomach showing fibroid thickening at the

oesophageal orifice, with sloughing of the mucous membrane, for
about three inches beyond this, on the anterior and posterior
walls, near the lesser curvature. On the anterior surface it
almost reaches the peritoneal coat ; on the posterior, the organ
is firmly fixed to the pancreas. Sections made through the
indurated coats of the stomach in close proximity to the slough-
ing ulcer at the oesophageal end exhibit, under the microscope,
no cancerous structure. The peptic and other glands are found
atrophied, and the submucous and muscular coats thickly in-
filtrated with fat granules and globules, small free nuclei, and
blood cells. In parts also an abundance of micrococci is found.
The ulceration and induration both appear to be simple in
character, and the result of very great loss of vitality and
physical prostration at the close of a lingering disease (chronic
dysentery), from which the patient, a European (male), aged 53
died. ( See further, “ Medical Post-mortem Records,” vol. II,
1870, pp. 01-02.)

SEKIES IS.]

GASTRIC ULCER.

287

36. “ The stomach of an East Indian child, aged about six months.

Its coats are very much softened and gelatinized, and a large
perforating ulcer is seen at the fundus towards the splenic end.
The spleen was found applied over this opening, and prevented,
to some extent, the escape of the contents of the stomach into
the general peritoneal cavity. The child died from inanition.”
(Presented by Professor C. 0. Woodford.)

37. A stomach the mucous membrane of which is displayed exter-

nally to show the general thinning, superficial softening, erosion
and pitting which it has undergone, apparently, chiefly from
post mortem digestion, but also probably as the result of long-
continued disease of the alimentary canal. The subject was
a native female, aged 50, who died very much emaciated and
completely worn out from extensive ulceration of the rectum
following upon dysentery. The autopsy was performed 71-
hours after death.

38. Ulceration of the mucous membrane of the stomach. Four ulcers

are seen in the preparation,— three at the pylorus, one near the
lesser curvature. Of the former, one has perforated all the
coats of the organ ; the other two expose the muscular coat.
The ulcer at the lesser curvature is deep, somewhat funnel-
shaped, and the size of a two-anna piece. It also perforates all
.the ventral tunics. The mucous surface, for about half an inch
around it, is thickened and rough ; the peritoneal coat, to about
the same extent, shows similar changes.

All the ulcers have clean-cut, sharp margins, and present a typically
punched-out appearance. No history. ( Presented by Professor
Edward Goodeve.)

39.

40.

•41.

“ Perforating ulcer of the stomach, situated at the upper and
posterior surface of the organ, near the lesser curvature. The ulcer
is about the size of a shilling, with thickened and defined edges.
The perforation is somewhat oblique, and would admit a
No. 12 catheter. The parts of the stomach around the ulcer
are thickened and indurated; the organ is otherwise healthy.
Its _ peritoneal covering has some flakes of lymph adherent
to it (as also had that of the lower surface of the liver).—

a European (male) patient, who died of peritonitis.”
(Colics.)

The pylorus and adjacent portion of the stomach, showing several
chronic shallow ulcers affecting the mucous membrane. A rin^
of these, undergoing cicatricial contraction, is situated at the
pylorus itself, and has produced much narrowing and con-
striction of this orifice, with which is also associated a good
deal of annular thickening of the submucous coat. The ulcers
have sharply-defined, “ punched-out ” looking edges, and in
the recent state, were covered with a little soft, rusty-lookino-
material, probably altered blood— Taken from a native male

?£ed ??» ,who died much emaciated from chronic diarrhoea
( • Medical Post-mortem Records,” vol. II, 1876, pp. 39.40 )
Perforating ulcer of the stomach. This organ is We and
dilated at the (esophageal end, but the mucous membrane^here is

288

GASTRIC ULCER.

[series IX.

quite healthy. At the pylorus, about half an inch from the
pyloric orifice, and on the anterior wall of the stomach, near
the lesser curvature, there is a perforating ulcer, irregularly
rounded in outline, and about the size of an eight-anna
(shilling) piece. Its margins are thickened and anaemic. It
has a funnel-like shape when viewed from the interior, owing to
the gradual and unequal invasion of the successive coats of the
stomach from within outwards. The latter are matted together
and immovable upon each other. For half an inch around
the spot where the ulcer has perforated, the peritoneal . coat is
covered by much granular recent lymph. The opening has
sharp edges, and a cleanly “ punched-out” character.

The peritoneum generally was acutely inflamed; the coils of the intestine matted
together, and the pyloric end of the stomach glued to the under surface
of” the liver. There was no injection or inflammatory redness of any
portion of the ventral mucous membrane. The ulcer seems to have been
of Ion" standing, but the perforation was probably sudden, and acute
peritonitis the fatal result. In the stomach about two ounces of partially
digested food was found (potato-peelings and other vegetable matter).

The patient, a Mahommedan, aged 32, by occupation a mason, was
brought into hospital moribund and collapsed, and died about
five hours after admission. It was ascertained that he had
suffered from dyspepsia for about four months. He had come
home from work in the evening, and partaken of. his usual food,
but was, almost immediately after the meal, seized with a sharp
catching pain at the pit of the stomach. This had gradually
increased and extended over the rest of the abdomen. There
was no history of a blow or any other external injury, {bee
further, “ Medical Post-mortem Records,” vol. II, 1877,

pp. 437-38.) *

42 Pyloric end of the stomach and duodenum with several chronic
ulcers, involving the mucous and submucous coats. They
have abrupt, well-defined margins; slightly softened, and
slomdiy surfaces. In the duodenum there are two ulcers, each
rather larger that a split-pea, and numbers of small, superficial,
pitted erosions.— -From a native female, aged 50, who died
from chronic Bright’s disease. (“ Medical Post-mortem Records,
vol. Ill, 1880, pp. 409-10.)

42 The stomach of an East Indian lad, P. J., aged 16, who died
from pulmonary phthisis (tubercular), showing numerous ir-
regularly scattered, small, opaque-white granules, and a few
superficial ulcers. The former are about the size of sago-grains
(or a little larger), of lymphoid structure at the periphery,
caseous at the centre, and situated in the submucous tissue.
The latter have hard and rounded margins and pitted surfaces.
Both are evidently tubercular in character, and have probab y
originated in the submucous glandular and peptic follicles ot

44 P vh)ific° end of the stomach and duodenum. The former exhibits,

just above the pyloric ring or orifice, a small ulcer, the size
a two-anna (three-penny) piece, with raised thickened edQ

sEHiEs ix.] PERFORATING ULCER OF STOMACH.

289

The latter presents a series of similar but larger ulcerated
patches involving the transverse folds of the mucous membrane.
All these are tubercular. The rest of the small intestine
was thickly covered vs itli very characteristic ulcerations of the
same kind. — From a case of tubercular phthisis, — a native female,
aged 25. (“ Medical Post-mortem Records,” vol. II, 1876,

pp. 23-24.)

45. Perforation of the stomach following chronic ulceration. From
a sepoy named Maddhu. The perforation is about the size of

, a two-anna (three-penny) piece, and has a very clean-cut,
“ punched-out ” looking margin. The peritoneal coat, for about an
inch around the perforation, is puckered, thickened, and opaque-
looking. ( Presented by Dr. C. R. Francis.)

46. “ Pylorus, duodenum, and pancreas of a native who died from
haemorrhage caused by a malignant ulcer of the pylorus, opening
into the gastro-duodenal artery. The ulcer is about the size
of a six-pence, and is situated just within the pylorus. A red
glass rod lias been passed into the gastro-duodenal artery and out
through the ulcer. .Beneath the pylorus and in front of the head
of the pancreas is an enlarged gland, the size of a grape. It showed
nucleated cells under the microscope.” (Colles.)

47. The stomach of a Mahomedan (male) aged about 60, brought to

the hospital in a moribund condition with symptoms of intes-
tinal obstruction and peritonitis, and who died, unrelieved, eleven
hours after admission.

The stomach is seen to be elongated, somewhat sausage-shaped. At the
pyloric ring there is a deep ulcer,' about the size of a two-anna
piece, and another partially cicatrised ulcer, of the same diameter
near it. The former has perforated all the coats of the viscus*
and was the cause of the acute peritonitis from which the
patient died.

About six ounces of dark tar-like material (altered blood), was found
in the stomach, and some undigested food (potatoes, rice, &c.).
Two pints of dark brownish, highly bilious fluid was extravas-
ated in the peritoneal cavity. Around the margins of the per-
foration, on the outer aspect of the stomach, there was a thin
film of recent rosy lymph, which served to glue it partially to
the under surface of the liver. No cancerous or any other
morbid growth is found developed in connection with the
stomach ; the pylorus, however, is much narrowed and contracted
barely admitting the passage of the little finger. This is prob-
ably attributable to the partial cicatrisation of the ulcers
above described, and the consequent puckering and thickening
of the surrounding mucous membrane. The muscular coat of
the stomach is throughout considerably thickened and hyper
trophied. J 1

<48. Scirrhus of the pylorus, with great thickening of the walls of the
stomach. The pyloric orifice is much narrowed and contracted
from the presence of a hard irregular-outlined growth, within
and external to the coats of the stomach at ' this situation

290

SCIRRHUS OF THE PYLORUS.

[series IX.

The section which has been made through this part is quite an
inch in diameter. A large projecting mass is also situated just
below the pylorus, intimately connected with the thickening of
this part, and continuous with it. It has, when incised, an
opaque, yellowish-white, fibrous appearance, and very dense
resistant consistency, except over a small space where the growth
has undergone softening.

Examined microscopically, the structure of the growth is typically scirrhus. Well-
formed alveoli, with polymorphous nucleated cells in great numbers are
clearly distinguished, and the infiltration involves all the coats of the
stomach in and around the pylorus.

The oesophageal opening is normal. The coats of the stomach are
throughout much thickened ; this condition, however, affecting
principally the muscular tissue. The mucous surface is thrown
into thick longitudinal rugse or folds ; a deep continuous circle of
ragged ulceration affects it just within the pylorus. No
history.

49. Scirrhus of the pylorus. The pyloric end of the stomach is seen to
be the seat of extensive nodular growth. Projecting from the
inner surface is an irregular-outlined tumour, the size of a small
orange, encroaching upon, and apparently almost completely
obstructing, the pyloric orifice. On the oesophageal side of this
growth there is a deeply excavated ulcer, about three inches in
diameter, exposing the submucous and muscular coats, and with
small nodular excrescences scattered over its surface. Its edges
are hard, abrupt, and rugged. The rest of the stomach presents
a highly thickened and prominent condition of the mucous and
muscular coats. The oesophageal opening is not involved.

The peritoneal surface of the stomach is also throughout thickened, and
in parts raised into small, flattened, nodular growths, particularly
over the pyloric half.

On making incisions through the thickest part of the pyloric tumour, it
is seen to present a coarse, fibrous-looking structure, and all the
coats of the stomach appear to be involved in the morbid growth,
— the transverse bands of the muscular coat being readily recog-
nisable. The consistency is very firm and resistant, creaking
under the knife.

On microscopical examination, the cancerous growth is not found so diffusely
disseminated as appears on first sight. The superficial layers of the mucous
membrane, and even much of the glandular structures in the submucous
tissue, show nothing more than abnormal and excessive hypertrophy. It is
in the submucous, muscular, and deeper strata that the differentiation into
cancerous structure becomes most marked, and here presents all the
characteristics of scirrhus.

The duodenum for its whole length was found united by old peritonitic
adhesions to the greater curvature of the stomach, — a portion
being still left in situ. The mesenteric glands were also firmly
fixed to the under surface of the organ, and apparently enlarged
and swollen from cancerous infiltration. No history.

SERIES IX.]

CANCER OF THE STOMACH.

291

50. Carcinoma of the pyloric end of the stomach, involving also, the
pancreas. The growth forms a firm, nodulated mass surround-
ing the pylorus externally, and as ragged nodules, and irregular
shaped ulcers, affects the mucous membrane. The pyloric orifice
is much encroached upon and narrowed, while the walls of the
stomach beyond have undergone compensatory hypertrophy, —
particularly as regards the muscular coat. The microscopic
structure of the growth is not very distinct, owing to the long
maceration of the preparation in spirit ; but, as far as can be
ascertained by several sections taken from both pylorus and
pancreas, is that of scirrhus. ( Presented by Dr. H. L. Lees,
Civil Surgeon, Akyab.)

51. Epithelioma of the stomach. A large fungating growth involves

the pyloric half of the stomach, the rest of this organ being
contracted, and showing much thickening of its walls, especially
of the muscular coat.

The growth commences at the pyloric orifice, which has evidently been
greatly constricted, and spreads backwards from this spot for
about three inches, implicating chiefly the mucous coat. It
stands out prominently and abruptly fron the unaffected portion
of the stomach, has irregularly-rounded margins, and a broadly
villous, lobulated and spongy surface. The average thickness is
about half an inch, but, at the pylorus (thickest part), measures
quite an inch. The peritoneal coat of the stomach is opaque
and thickened. The lymph glands along the lesser curvature
are enlarged and infiltrated. The oesophageal opening is normal.

' Microscopically examined, the growth is seen to possess all the characters of true
glandular epithelioma. The asceni of the peptic and follicular glands of
the stomach are found dilated and irregularly expanded, and are filled with
large masses of swollen, granular, and fatty epithelial elements. These are
of both the spheroidal and columnar type. In all the sections the morbid
prolifersttion is seen to have passed beyond the original or proper glandular
structures (matrix) into the surrounding submucous tissue; large numbers
of nuclei and small cells are thus found around and beyond the primary seat
of the disease, burrowing, and causing its extension into the deeper
structures.

* 52. “ A large rent in the stomach, about three inches from the pylorus,
apparently the consequence of malignant disease.” (Ewart.)
No history.

■ preparation the stomach has been turned inside out, and, at the

pyloric end, a ragged surface of deep ulceration is seen, varying
lrom one to two and a half inches in breadth, and involving
almost the whole of the mucous surface. The edges of the ulcer
are raised, tuberculated, irregular, very hard and dense. The
muscular coat of the stomach is freely exposed, exhibits scattered
nodules of morbid growth, and, in two situations, the base of the
ulcer presents perforations or ruptures through all the tunics of
the organ, — the one being a ragged rent, rather larger in area
than a rupee (florin), the other, a rounded perforation, with a
smooth margin, capable of admitting a goose-quill. This
circle of ulceration is situated, not at the pyloric orifice itself,
but at a distance of from one to two and a half inches from it,

292

CANCEK OF THE STOMACH.

[SElilES IX.

encroaching more upon the pylorus at the lesser than at the greater
curvature of the stomach. The pyloric orifice is a good deal con-
tracted, and all the coats of the stomach here thickened and
infiltrated. The mucous membrane on the oesophageal side of
the ulcerated growth is somewhat abnormally thickened for about
two inches, beyond which there is no marked change observable.
The duodenum (which has also been preserved) is healthy.

Examined microscopically, sections sliow all the characters of true epithelioma,
commencing evidently in the original glandular structures of the mucous
and submucous coats, and spreading as an infiltration into the surrounding
parts. Large tubular processes or prolongations of epithelial masses are
found ; the cells are much fused together, of large size, and apparently both
of the spheroidal and columnar type, — the latter predominating. They are
all in a high state of fatty degeneration.

53. “ A lobulated cancerous mass surrounding the cardiac orifice of the

stomach, which it constricted so closely that the patient died of
inanition. The glass rod now in the cardiac orifice was passed
with difficulty ; it is about the size of a No. 12 catheter. The
right lung contained numerous deposits, varying in size from
that of a cherry to that of a cherry-stone. The left lobe of the
liver was full of others, as large as split-peas. Patient an
Englishman, aged 73.” (Colles.)

The growth has a fungous appearance, consisting of a series of tufted masses, from
a quarter to half an inch in length, closely set together, and closely surround,
ing the cardiac orifice of the stomach. The tissue is soft and succulent. On
microscopic examination the structure consists of elongated, papillated
outgrowths or tubules, densely packed or filled with cylindrical nucleated
epithelial cells and free nuclei, with granular and molecular fat. These
are held together by delicate connective tissue, in parts infiltrated with
a small nuclear growth, and supporting large blood-vessels. The characters
therefore are those of epithelioma of the cylindrical or columnar variety.
(Presented hy Professor Chuckerbutty.) *

54. A portion of the stomach of a horse, exhibiting a transverse

rupture of all the coats, about 2£ inches in length, situated on
the posterior surface of the organ, near the greater curvature.
Internally, the mucous membrane all round the rupture appears
to be thinned ; externally, the peritoneal coat is seen to have
given way not only to the extent of the rupture above described,
but also for from to 3 inches on either side of ( i . e. beyond) it,
so that the tear in the serous investment is quite eight inches in
length. All round this part soft exudation material can be
traced, as if an attempt at repair had already been made.

“ The subject showed colicky symptoms, and as usual became easier
before death.” ( Presented by K. S. Hart Esq., m.r.c.v.s.,
Calcutta.)

55. Portions of the stomach, great omentum, and diaphragm of a

horse. Sections prepared from all these parts for the micro-
scope reveal a very extensive infiltration of soft or enkephaloid
carcinoma, taking a nodulated or tuberculated form. The walls
of the stomach are greatly hypertrophied. The great omentum
looks just as if small lumps of white wax had been scattered over

SERIES IX.]

RUPTURE OF THE INTESTINE.

293

its surface. Both stroma and cell-elements are well defined, and
in parts also the extension of the latter into the surrounding
structures by division and free multiplication of nuclei.
( Presented by R. S. Hart, Esq., m.r.c.y.s., Calcutta.)

56. A section from the stomach of a horse, from near the greater

curvature, showing a nematoid cyst or nest, which was occupied
by several filiarae (F. Megastoma). {Presented by R. S. Hart,
Esq., m.r.c.v.s., Calcutta.)

57. “ A portion of the small intestine displaying a rent or rupture

an inch long. It runs transversely to the longitudinal axis of
the gut ; its edges are almost as even as if the opening had been
made with a knife. The injury was inflicted by a blow on the
abdomen. The patient died of peritonitis forty-eight hours
after the accident.” (Ewart.)

58. Traumatic rupture of the small intestine (ileum), produced by a

blow on the abdomen from a stick. Death from peritonitis
took place twenty hours after the receipt of the injury. The
rupture is about half an inch in length, in the transverse dia-
meter of the bowel. The mucous membrane is seen protruding.
The peritoneal coat is covered with flaky lymph, which material
may also be observed feebly matting together the folds of the
intestine. Lumps of hard foeces were found in the large gut,
which may possibly have predisposed to the causation of the
rupture above described.

59. “Three portions of the small intestine of a native hoy (Hindu),

aged ten years, who fell from the roof of a house, a distance of 20
feet, on to the hard roadway. Was admitted into hospital with
a fractured lower jaw, and several of the front teeth driven
deeply into the upper jaw. He had been insensible, but, when
admitted, was conscious, and complained of intense pain in the
abdomen, about the umbilical region, and downwards therefrom.
He died ten days after.

“ At th z post-mortem examination we found complete rupture of all the
coats of the intestine, with extravasation of its contents, and
acute and general peritonitis.” (Ewart.)

The rupture is only complete at two points in one of the smaller portions of the
ileum. One spot is the size of a four-anna piece (sixpence), the other
would admit a crow-quill. In the other smaller bit of intestine there is a
large incomplete rupture, the mucous and submucous coats protruding-
outwards (henna-like) through the muscular and peritoneal coverings which
have given way; and this same condition (incomplete rupture) is observed
at two spots in the third coil of intestine preserved. J. F. P. McC.

60. About six inches of the jejunum, showing rupture of the bowel
with eversion of the mucous membrane over a space the size of
a lour-anna piece (six-pence), the whole being surrounded by much
recent lymph. J

History. Dookhan, aged 30, a bearer, whilst engaged with others in
carrying Up an aim, rah to the third story of a house, accidentally
lost his balance and fell. He was admitted into the Medical

294

RUPTURE OF THE INTESTINE.

[SEEIES IX.

College Hospital on the 24th December 1878, and died on the

26th.0

Post mortem examination. — “ There were several contusions over the
body ; the lungs and liver were congested ; the heart was healthy;
the spleen, kidneys, and stomach were also healthy. This
rupture through the coats of the bowel at the lower end of the
jejunum was°found. Peritoneum throughout highly inflamed.
The outer surfaces of the intestine were matted together by
hands of lymph. There was a small quantity of foecal matter
in the abdominal cavity. Death evidently due to peritonitis.”

( Presented by Dr. S. C. Mackenzie, Police Surgeon.)

61 A portion of the jejunum (from about its middle third) exhibiting
a rupture sufficiently large to admit a crow-quill. The mucous
membrane is partially everted through this opening, and,
around its margins, lymph is seen to be deposited. This served
to glue the injured bowel to a neighbouring coil, but did not
prevent fsecal extravasation and consequent acute peritonitis,
from which the patient, a native (male), aged 30, died, 52
hours after the receipt of the injury.

The deceased was employed as a coolie on the Suburban Railway, and,
during the process of shunting some empty trucks, got jammed
between two of them. ( Presented by Dr. S. C. Mackenzie, Police

6°. A portion of the small intestine, and the sigmoid flexure and
rectum of Miskun Sowar, 1st Troop, 19th Bengal Lancers, aged
17 who died at Lucknow from the effects of a bamboo-stick
being thrust into the rectum. “ The morbid specimen shows
the wound of the rectum, remains of effused blood on the
sm-moid flexure, and several boles or wounds of the small
intestine produced by the pointed end of the bamboo after it
bad pierced the rectum, striking the small intestine where it
rested on the spine and prominence of the sacrum. the
patient died from peritonitis, but survived these very severe
injuries for no less than 29 days. “ The deceased was a Pathan,
and is supposed to have been in the habit ot submitting to the
practice of sodomy with one of the (three) men concerned in the
outrage, and the latter had become enraged against him by
his having conferred his favour on another man. All the three
men concerned in the outrage were Pathans, and were under
the influence of' churrus at the time the deed was done. {Pre-
sented by Surgeon-Major G. A. Watson, 19th Bengal Lancers,
Lucknow.) See also Indian Medical Gazette , vol. IX, 1874,

Duodenitis. A portion of the duodenum from a case of abortion,
suspected to have been induced by the administration ot some
irritant drug or poison, though none was discovered either during
life or postmortem. The specimen shows a very peculiar rough-
ened condition of the mucous membrane, as if the epithelial
laver had been scraped away. Brunner’s glands are also enlarged
and prominent. This appearance of the mucous surface was
also observed in the stomach and throughout the small intestine,

series ix.] AMYLOID DEGENERATION OF INTESTINE. 295

but was most marked in the duodenum. There was, in addition,
intense vascularity and even ecchymosis of the affected parts.
( Presented by Dr Chuck erbutty.)

64. The duodenum from a case of arsenical poisoning,— a native female,

aged about 20. There is intense congestion, vascularity, and
pulpy softening of the mucous membrane, and several smaller
and larger masses of yellow arsenic are seen impacted between
the valvulse conniventes.

65. Duodenitis. A portion of the duodenum, the mucous membrane of

which is much thickened and shows superficial excoriation of the
epithelial layer. No history.

66. Amyloid infiltration of the intestine. The lower portion of the

ileum of a female patient, aged 35, who died from chronic
dysentery, showing a catarrhal condition of the mucous
membrane, which also, in the situation particularly of the
glandular structures (Peyer’s patches and solitary follicles), gave
a distinct reddish-brown reaction with iodine solution (amyloid
or albuminoid degeneration). The kidneys were similarly
affected.

67. A portion of the ileum, preserved on account of the remarkably

characteristic reaction of amyloid or albuminoid infiltration
obtained with solution of iodine over the entire mucous membrane
more distinct in some parts than in others, and especially
marked in the zone of vessels surrounding the patches of Peyer
and solitary glands.

68.

Similar changes were met with in the liver, spleen, and kidneys. From

an East Indian (male), who died of chronic dysentery, and had
also commencing pulmonary phthisis.

Amyloid or albuminoid infiltration of the mucous membrane of
the small intestine (ileum). There is no marked alteration in
the structure of the coats of the bowel, but, in the fresh state
a very distinct and characteristic reaction was obtained with
iodine solution, in the form of reddish-brown streaks and
ramiform configurations, particularly in connection with the
patches of Peyer, indicative of the altered condition of the
walls of the small mesenteric arteries here distributed.
Similar (amyloid) changes were met with in the spleen and
kidneys.— From a native (male) patient, aged 30, admitted into
hospital very low, anaemic, and with general anasarca. The urine
contained albumen. There was fever and bronchitis ; the latter
passed into pneumonia, from which he died on the eleventh day.

The lower end of the ileum showing considerable prominence and
enlargement of the patches of Peyer and solitary glands. From
a case of cholera. The specimen illustrates one of the most
frequent post mortem appearances met with in connection with
the bowel in malignant cholera.

The last twelve inches of the ileum, with the coecum from a
patient, a Hindu, aged 40, who died in the collapse ’stao-e of
cholera The mucous surface of the bowel shows great promin-
ence and infarction of the solitary glands and patches of Peyer

‘70

296

THE INTESTINE IN CHOLERA.

[series IX.

73.

with superficial pitting of the follicles in some parts. The
changes are similar, though not so pronounced, in the large gut.

The production of this condition may probably be attributed to the
increased activity of all the glandular structures of the intestine,
and the shrinking, from loss of moisture, of the surrounding
parts— the other tissues pf the bowel. ( See also prep .No. 1.)

71. The lower portion of the ileum, the ccecum, and ascending colon,
exhibiting enlarged solitary follicles and Peyer s patches ; several
of the latter present slightly pitted surfaces. In the large
intestine the solitary glands are similarly swollen and prominent.
From an East Indian boy, aged seven, who died from cholera.

( See also prep. No. 4.)

A portion of the ileum with the ccecum of a native child, aged
two years, who died [collapsed) from cholera. Prominence and
enlargement of all the solitary glands and patches of I eyer are
well seen, the morbid condition being more than usually exaggerat-
eel, probably on account of the normal excessive activity and
development of these structures at this early period of life.
The mesenteric glands— preserved with the specimen— are also
enlarged, and were slightly hypersemic.

The intestine in cholera. The last two feet of the ileum and the
ccecum are preserved. There is great enlargement, opacity,
and prominence of the glandular structures, particulaily of the
solitary follicles in the small intestine. The intervening mucous
membrane is soft and pulpy, in several places shows bare patches
from extensive shredding of epithelium.

From a European seaman, aged 26, who died in hospital in the
“ collapse stage ” of cholera five and a half hours aftei admis-
sion. ( See also prep. No. 6.)

Simple ulceration of the jejunum, from . “a case of continued
fever. The valvulse conniventes were tinged and swollen, and
the mucous membrane is ulcerated in several places.” (Ewart.)
Chronic follicular ulceration of the small intestine. A portion of
the jejunum and ileum were only affected, and have been pre-
served. The ulcers in both situations are similar. They are
broad, stretch right across the bowel, have ragged and thinned
edges’ and slightly roughened or irregularly thickened bases.
There is no induration or caseation as in tubercular ulcers. In
the upper part of the ileum one ulcer has penetrated as deeply as
the peritoneal coat, which, in turn, has given way, and a per-
foration, about the size of a crow-quill, has taken place. I he
edo-es of the perforation are thin and sharply defined. Acute
general peritonitis resulted, from which the patient died. .

Thinner life the intestinal lesion was unsuspected. The patient, a
"European (male), aged 25, was admitted suffering from both
external and internal haemorrhoids. He was operated upon tor the
former and had apparently recovered. He was constipated and
dyspeptic while under observation, and occasionally referred to a
pain at the epigastrium, but not at any other part of the ab-
domen. No acute symptoms whatever were present during me
until the fatal peritonitis supervened.

74.

75.

SEiilES IX.]

TUBERCULAR ENTERITIS.

297

7(3. A portion of the jejunum with large, transversely-placed, indolent-
looking ulcers, apparently chronic in character, and partially
cicatrised. From an East Indian female. The ulcers stretch
right across the gut, and are from one to two inches in length.
Their margins are somewhat abrupt ; their bases irregularly
thickened, but not from any tubercular deposit. (Chronic fol-
licular enteritis.)

77. About the lower eight inches of the ileum showing well-marked

tubercular ulceration of two patches of Peyer. The upper one
is seen to lie transversely, and to involve about three-fourths
of the circumference of the gut ; the lower ulcer stretches com-
pletely across it. Both exhibit characteristic thickening of
margins, mainmillation of bases, and subperitoneal tubercular
deposit. (No. 1197, Ewart’s Catalogue, entered as “ Typhoid.”)

78. A beautiful example of tubercular ulceration of the intestine.

The disease involves the lower half of the ileum, and extends
beyond the ileo-coecal valve into the coecum. The glandular
structures (solitary follicles and patches of Peyer) are seen in
various stages of infarction and ulceration. The ulcers are
irregularly rounded or oval ; their margins thickened and raised ;
their bases rough and mammillated at the lower end, thin and
smooth at the upper portion of the intestine preserved ; and,
here also, the coats of the bowel generally are very thin and
semi-transparent. The ileo-coecal valve lias been almost com-
pletely destroyed.

79. About two feet of the lower end of the ileum showing very

characteristic tubercular ulceration of the glandular structures.
The ulcers are placed transversely, and stretch right across the
gut. They have raised, thickened, infiltrated margins, and
pitted surfaces, with irregularly distributed yellowish-white
nodules. The peritoneal coat is thickened and raised by similar
opaque-white granules.

All the mesenteric glands are cheesy ; several enlarged to the size of
a pigeon’s egg.

80. The coecum and ileum of an East Indian (male) patient,
who died from tuberculosis (phthisis and tubercular enteritis).
The whole of the mucous membrane is studded with large,
more or less rounded or circular ulcers, having thickened raised
edges, and granular, nodulated bases,— both being infiltrated with
tubercle. . Fine, granular, yellowish-white deposit of the same
material is seen immediately beneath the peritoneal coat opposite
each ulcer. The size of these ulcers varies from a crown-piece
to a split-pea. A large irregular patch occupies the ileac side of
the ileo-coecal valve, which has thus been destroyed considerably,
and the remaining portion of its structure is rough, thickened, and
infiltvated. The disease is seen to have extended into the large
intestine. Scattered ulcers of various sizes were found in several
portions of the colon. But in the coecum it is most advanced
eleven deep ulcers being found in the mucous membrane of this
part, each of them typically tubercular.

298 TUBERCULAR ULCERATION OF INTESTINE, [series ix.

81. A portion of the small intestine (ileum) exhibiting several large

tubercular ulcers, placed transversely, and embracing the whole
diameter of the bowel. Their margins are raised, hard, and
irregular ; their surfaces markedly mammillated. There is also
much tubercular infiltration of the peritoneal coat. — From a
native female, who died in hospital.

82. A portion of the ileum preserved to show the appearance presented

by cicatrising and cicatrised tubercular ulcers, with the con-
sequent star-shaped puckering of the surrounding mucous mem-
brane and narrowing of the calibre of the gut. The extreme
thinness of the intestine — the wasting that has affected all its
coats — is also well seen. — From a Hindu female, aged 45, who
died from pulmonary phthisis.

83. The upper third of the ileum from an East Indian male, aged 22,

who died from pulmonary phthisis, showing cicatrising tubercular
ulcers, with characteristic puckering and contraction of the
bowel.

84. A portion of the ileum with numerous partially or completely

healed ulcers, which for the most part extend transversely across
the gut, have raised, thickened margins, and puckered, cicatrised
surfaces, — evidently old tubercular ulceration. The great majority
were found quite free from any recent vascularity.— -From a native
(Bengali) female, aged 37, who died lrom pneumonia. (“ Medical
Post-mortem Records,” vol. Ill, 1SS0, pp. 745-46.)

85. Tubercular ulceration of the large intestine. The preparation

exhibits the sigmoid flexure and rectum, with numerous rounded
or irregular-outlined ulcers, which have remarkably hard, raised,
and thickened margins, especially in the rectum, and are evidently
tubercular in character.

The whole of the small intestine was similarly affected, including the
duodenum, and also, the pyloric end of the stomach. . ( See prep.
No. 44.) — From a case of tubercular phthisis, a native female,

aged 25.

86. Tubercular ulceration of the large intestine. The ccecum, appendix

cocci, and a portion of the colon of an East Indian (male,,
D. D’Rozario, aged 45, who died from pulmonary phthisis. The
appendix vermiformis shows much thickening of its walls, and a
bulbous dilatation of its free extremity. Its inner surface is
deeply ulcerated. Scattered ulcers exist in the coecumand ascend-
ing colon. These have irregular, hardened, prominent margins ;
their bases are mammillated, and expose the muscular coat. All
are evidently truly tubercular in character.

p specimen is chiefly preserved to illustrate the fact that, occasionally, tubercular
P leTions are developed in the large intestine as characteristically as. they
irenerally are in the small. The small intestine in this case was, curiously
enough, not affected. There was a little recent catarrhal dysentery of the
rectum, but the ulcers above described are not dysenteric.

87. The lower two feet of the ileum, with the cm cum and the mesen
teric glands from a case of typhoid or enteric fever.

series ix.] TYPHOID ULCERATION OF INTESTINE.

299

The patches of Peyer and the solitary glands in the whole of the portion
of the ileum preserved show various stages of progressive ulcer-
ation. Some are swollen and infarcted, with tumefied, fungous-
looking edges, others exhibit sloughs forming and still adherent,
or about to separate, and others, again, well-established ulceration ;
in all, strictly confined to the glandular structures, and placed
thus opposite to the attachment of the mesentery. The ulcers
increase in size and perfection as the ileo-coecal valve is approached,
just above which two very large and characteristic ulcers are
situated. The mesenteric glands are enlarged and swollen. No
history.

88. A portion of the ileum showing very typical typhoid ulceration of

the mucous membrane. The largest ulcers are oval in shape, from
halfaninchto an inch and a half in length, and involve the
whole of a Peyer’s patch. There are also mumerous smaller
ones, which evidently -correspond to the solitary glands ;
and many of the latter are seen in the earlier condition
of tumefaction or infarction. All the ulcers above de-
scribed have common characteristics. They stand out
prominently from the surrounding mucous membrane. Their
margins are abrupt, and strictly limited to the solitary or
agminate (glandular) structures affected. Their surfaces present
a peculiar pitted or reticulated appearance, from more or less
uniform rupture of the infarcted follicles, and thus illustrate one
of the modes of complete formation of ulcer in typhoid fever,
apart from sloughing (en masse). At the post mortem examin-
ation it was noted that “ the corresponding mesenteric glands were
also enlarged.” ( Presented by Dr. Scriven.)

89. The lower third of the ileum, the coecum, and the ascending colon.

This preparation exhibits most; typically the characters of true
typhoid lesions of the bowels. Throughout the portion of
ileum preserved, the glandular structures (patches of Peyer and

solitary follicles) are seen tumefied, swollen, and prominent,

many ulcerated. The last, chiefly near the ileo-ccccal valve,
which itself shares in the morbid process, and, immediately above*
it, may be observed three large “ patches ” which have almost
coalesced, and present thus a broad and deeply-excavated surface,
nearly four inches in extent. In the upper part of the ileum
the glandular structures are only superficially ulcerated, their
surfaces pitted, and the sloughs still adherent.

The portion of the coecum and ascending colon preserved exhibit similar
changes in the solitary follicles, indicating, therefore, an exten-
sion of the disease beyond the ileo-coecal valve, but affecting in
the large as in the small intestine, principally, and almost
exclusively, the glandular structures, not the general mucous
surface. ( Presented by Dr. Scriven.)

90. The coecum and about six inches of the ileum, showing, in the
latter, the changes in the glandular structures characteristic of
typhoid or enteric fever. The coecum is healthy. The ileo-
coecal valve much ulcerated on its ilcac surface. Just above
it is a large, deeply-ulcerated Peyer’s patch, and higher up

30Q

TYPHOID ULCEEATION OF INTESTINE. [series is.

two plaques with swollen, infarcted margins, and irregularly
pitted surfaces ; while the solitary follicles scattered over the
rest of the mucous membrane present a prominent and raised
condition also. Such of the mesenteric glands in the neighbour-
hood of the ileo-coecal boundary as have been preserved exhibit
an enlarged and softened condition. No history.

91. Ccecum, with a portion of the ileum, showing infarction and typhoid

ulceration of the patches of Peyer in the latter. — From a
European seaman, Henry Moore, admitted into hospital on the
14th and died on the 25th December 1864. ( Presented by

Professor Norman Chevers.)

92. The lower portion of the ileum and the coecum of a sepoy, “who

died of typhoid fever in the regimental hospital, on the night
of the lith June 1872, i.e., on the 12th day, the fever having
begun on the 31st May.” Three large ulcers are seen situated
just above tbe ileo-coecal valve. A fourth, about four inches
above tbe valve. The larger ulcers are deep, exposing the
muscular coat, their edges are a little thickened and raised,
but undermined, and they occupy the positions, and partake
more or less of the outlines or areas of the patches of Peyer.
( Presented by Dr. H. T. Lyons, 8th N. I., Alipore.)

93. A portion of the intestine, consisting of about a span above and

below the ileo-coecal valve, — showing typhoid lesions. The
patches of Peyer and solitary glands are much enlarged, form-
ing rounded or oval prominent infarctions or plaques ; others
are distinctly ulcerated. A large “ patch,” immediately above
the ileo-coecal valve, is seen to have sloughed almost en masse;
one or two fragments of slough still adhere to the margins, but
the main bulk of the gland has exfoliated, exposing freely the
muscular coat. Above this ulcer are two other patches of Peyer
which exhibit partial tumefaction and commencing slough.
They are raised from the surrounding surface in button-like
projections, each about the size of a two-anna (three-penny)
piece. Their edges rounded 5 their surfaces pitted. Higher up,
other small circumscribed portions of Peyer’s patches and a
few solitary glands show tumefaction, and, in the recent state,
were highly vascular. The ileo-coecal valve is considerably
thickened. In the coecum, the solitary follicles exhibit, in
several places, a raised, prominent and infarcted condition, a few
being also pitted on the surface. These lesions were absolutely
confined to the portion of intestine preserved.— From a Hindu
(male), aged 21, admitted into hospital on the 14th June 1873.
It was said by his friends to be tbe 5th day of the fever. He
died 011 the 16th June, two days after.

On admission, the patient was delirious. The tongue and teetli covered with sordes.
There was subsultus tendinum and diarrhoea. Pain over the whole
abdomen, but especially elicited on pressure over the right iliac fossa.
“The highest temperature was 105°F (on the evening of admission), the
lowest 101° 2F. (shortly before death). lie was never free from delirium
while in hospital.”

sebies IX.] TYPHOID ULCERATION OF INTESTINE.

301

The mesenteric glands were enlarged and highly vascular, {see prep.
No. 241.) {Presented by Professor Chuck erbu tty.)

94. A portion of the ileum anti the ccecum of a European (male), aged
30, admitted into the hospital under the care of Professor
Cutcliffe, with popliteal aneurism, which was treated by com-
pression and cured ; but while still under observation (in
hospital), the patient developed symptoms of typhoid fever, of
which he died. The mucous membrane of the whole of the
ileum was found, post mortem, of a rosy-pink colour, and
for 3G inches above the ileo-coecal valve exhibited a morbid
condition of the glandular structures. The valve itself is
thickened, and on both its surfaces three or four small ulcers are
seen, with shreddy sloughs adhering to them. Two inches
above the valve, (in the ileum), is a large irregular- outlined,
ulcer, occupying a Peyer’s patch. The portion of the same patch
which is not ulcerated is soft, spongy-looking, raised for about
| of an inch above the surrounding mucous surface. The base
of the ulcer is formed partly by the muscular coat of the bowel,
partly by the peritoneal coat alone, which, at one spot, is as thin
as a wafer, and quite diaphenous ; moreover, perforation seems
to have been imminent here, since the external aspect of the
gut showed, (in the fresh state), not only great vascularity of
the peritoneum, but also, a circumscribed exudation of recent
lymph corresponding to the situation of the progressing
ulcer. Two small ulcers, each about the size of a pea, lie
about half an inch below the last described. They also
occupy portions of tumefied, vascular, and prominent Peyer’s
patches, and expose the muscular coat. Twelve inches above
the ileo-ccecal valve is another ulcer, the size of a four- anna piece
(six-pence), circular in shape, and also reaching the muscular coat ;
and a fifth ulcer, of almost identical shape and size, is situated
three inches above the last. In and between these ulcers, and
extending upwards in the ileum for the distance already
indicated, are numerous swollen, raised, and prominent patches
and solitary glands. In the majority of instances only portions
ot a patch, not its whole extent, are implicated, and, at the
centres of several of these tumefactions, small pitted depres-
sions (indicative of commencing ulceration) are also observed.

The whole of the mucous surface of the large intestine was abnormally
vascular, and covered with numerous small, circumscribed, more or less
rounded or circular ulcers, having the closest resemblance to thoso
a fleeting the solitary follicles in the small intestine, and evidently
originating and confined here, in the large gut, to the homologous glandular

95.

A portion of the ileum with the ccecum of a native child, who
died from typhoid (enteric) fever. The patches of Peyer and
solitary follicles throughout the lower half of the ileum are
enlarged and prominent, and the great majority of them
ulcerated. The ulcers increase in size and number as the ileo-
cceca1 valve is approached. In the last thirty inches of the
ileum they are extremely well marked. They arc rounded or

302

TYPHOID ULCEEATION OF INTESTINE. [series ix.

oval, as on tlie one hand the solitary follicles, or, on the other,
the patches of Peyer, are involved. Almost every patch in this
portion is in a state of acute slough. The largest of these
measures quite two inches in length by an inch in breadth, is
situated about six inches above the ileo-coecal valve ; another,
an inch in length by an inch and a half in breadth, about two and
a half inches above the valve; another just above

the valve ; and a fourth, the size of a rupee, close to it,
implicating also the ileac surface of the valve. All these ulcers,
and especially the largest, penetrate deeply, reaching even the
peritoneal coat, which is extremely thinned. Each large ulcer
was surrounded by a distinct hypenemic zone of dilated and
congested capillary vessels. The mucous membrane of the
large intestine is pale, and the glandular structures unaffected.
The mesenteric glands were enlarged and hypersemic. (See prep.
No. 242).

History.- Gopal, a Hindu boy, aged 8 years, was admitted into the College
Hospital, under the care of Dr. Chuckerbutty, on the 30th December 1874.
Ilis mother stated that about twenty-five days ago the child was attacked
with a continued fever, which lasted fourteen days. There was then no
fever for four days, when it returned, and has continued to the present
time For the last two days the child has been delirious. There lias been
no diarrhoea. Condition on admission was as follows -.—Body much emaciated ;
dark sordes on the teeth and gums ; tongue dry and fissured ; pulse small
•ind feeble, 112 per minute; much subsultus tendinum ; abdomen fiat;
considerable pain on pressure over the ccecum and near the umbilicus.
Patient delirious. He died exhausted on the afternoon of the 6tli January
1875, becoming quite comatose shortly before death.

The daily record of temperature is appended—

E. 103 GF.

96. A very typicals

series ix.] TYPHOID ULCERATION OF INTESTINE.

303

p. G2.) ( Presented by Dr. J. O’Brien, 43rd Assam Light

Infantry, Gowhatty, Assam.)

97. Another specimen of typhoid ulceration of the small intestine

“from a native recruit (Jerwah), aged 22, who died on the
14th day of the disease, of exhaustion, &c., (November 1873^).”
The glandular structures, particularly the patches of Peyer, §how
very characteristic fungoid prominence and infarction, and the
majority are more or less ulcerated, or covered with yellowish
shreddy sloughs. For about three inches above the ileo-coecal valve
the ulceration is more general, involving the entire mucous
surface for a space as large as the palm of the hand. ( See Indian
Medical Gazette, loc. cit.) ( Presented by Dr. J. O’Brien, 43rd

Assam Light Infantry, Gowhatty, Assam.)

98. The ccecum and about three feet of the ileum showing enormous
fungoid prominence, vascularity, and infarction of the patches of
Peyer and solitary glands, with also superficial sloughing of
portions of the former. The morbid changes become more
marked as the ileo-coecal valve is approached, the ileac side of
which presents an almost continuous mass of highly vascular,
coalesced, patches of Peyer, with here and there slight ulceration,
and small, still adherent, yellowish sloughs. The general mucous
membrane of this portion of the bowel had a bright rosy-pink
colour, and the mesenteric vessels and peritoneum immediately
over each patch were highly injected and of a dark purplish tinge.

The mesenteric glands were enlarged and intensely vascular and
soft ; some swollen to the size of a sparrow’s egg, particularly
those nearest the ileo-coecal valve. The spleen was large, heavy,
and dark. — From an Armenian boy, aged 7 years, admitted into
hospital on the 4th July 1875, and who died the next day. No
clear history of the attack could be obtained, except that the child
had been suffering from fever for about eight or nine days. It
was at first intermittent, had, however, for the last five days
become continued in character. The condition of the bowel points
unequivocally to true typhoid or enteric fever. ( See further,
‘'Medical Post-mortem Records,” vol. I, 1875, pp. 713-14.)

1 99. The last two feet of the ileum showing ulceration of the glandular
structures and perforation of the bowel. At the 'post mortem
examination the ileum presented a bright pink colour, and was
preternaturally vascular in its last thirty inches. In this portion
of the gut about a dozen large' and several smaller ulcers were
found. These involve (as may be seen in the preparation,)
the glandular structures, both solitary follicles and patches of
Peyer. They are sharply defined, have thin margins and vascular
bases formed by the submucous, muscular or peritoneal coat ; are
almost all bare, but a few have still small fragments of yellowish
slough adhering to them. They are rounded, oval or irregular
in shape, and are especially numerous in the last fifteen inches
of the ileum. The perforation alluded to has taken place at
the centre of one such ulcerated patch. It is sufficiently
largo to admit the point of a director, and is situated about

304

TYPHOID ULCERATION OF INTESTINE. [series ix.

eight inches above the ileo-ccecal valve. Foecal extravasation
with acute general peritonitis was the fatal result. The mes-
enteric glands, enlarged, soft, swollen, and vascular, are preserved
with the" bowel. Taken from a native (male) child, aged about
two and a half years, who had been suffering from fever for about
twenty days, was admitted into hospital in a very low and
almost insensible condition, and died within twenty-four hours,
with symptoms of acute peritonitis (22nd July 1875).

100. About the lower three feet of the ileum and the coecum show-
ing great swelling, tumefaction, and commencing ulceration of
the glandular structures,— solitary follicles and patches of Peyer
in the former, and solitary glands in the latter, lesions charac-
teristic of typhoid or enteric fever. The mesenteric glands are
also preserved. They are enlarged, swollen, and highly vascular.

The subject was a native male (Hindu), aged 34, who was brought to
the hospital in a moribund condition, and died within an hour
after admission. His Iriends stated that he had been suffering
from continued fever for six days, during the greater part of
which he had been delirious and unable to partake ol any
kind of nourishment. (For further description, see “Medical
Post-mortem Records,” vol. II, 1877, pp. 413-14.)

101. Typhoid ulceration of the intestine. From a European boy,
aged 12 years. He was admitted on the 15th February
1878 for chronic ulceration of the cornse, and developed the
fever while in hospital, on or about the 15th April (18/8).
Was transferred to the medical wards on the 17th April, and
died on the 20th April— i.e., on about the sixth or seventh day
of the disease. The coecum and about five feet ot the ileum are
preserved. In the latter the patches of Peyer and solitary glands
are all much enlarged, prominent, and infarcted ; form veiy chaiac-
teristic fungoid-looking projections from the surrounding mucous
surface. Some present also a superficially pitted or ulcerated con-
dition. The largest patch, situated a little above the ileo-coecal
valve, is cpiite four inches in length and an inch and a half in
breadth. There was slight prominence and infarction ol the
solitary glands in the coecum and ascending colon. The mesenteric
glands were swollen and vascular. The spleen large, dark, and
soft, — weighed 9|oz.

No eruption on the skin was discovered at any time in this case, though . carefully
looked for. There was distinct pain on pressure over the right iliac
fossa, but no gurgling. The stools were highly bilious and offensive,
passed very frequently, and often involuntarily. The temperature was
throughout high ( see below). On the 19th the patient was delirious, and on
the afternoon of the 20th April, when the temperature reached 107 if.,
he became livid and insensible.

Temperature Table.

3rd day ... 17th April

4th „ ... l^th ,,

5th „ ••• 19th „

6tli „ ••• 20th „

falling to 101 OF. shortly before

104°F.

104°2

))

104°2„

104°

104°8 „

103°8

))

107° „

eath.

skuies ix.J TYPHOID ULCERATION OP INTESTINE.

306

He was at first treated by quinine and digitatis given internally ; afterwards, — as
the high temperature persisted,— by cold baths, ice to the head, and hypo-
dermic injections of neutral quinine.

(See further, “ Medical Post-mortem Records,” vol. II, 1868, pp. 769-70 )

102. A similar specimen from a native (Hindu) female, aged 15.

There is prominence and infarction of the patches of Peyer, and super-
ficial pitting (ulceration) of those nearest the ileo-coecal valve.
The mesenteric glands were enlarged, dark, and soft. The spleen
increased to about twice its normal size, very vascular and pulpy.

The patient was admitted into hospital on the 1st February 1879, with a history
of having suffered from fever for a fortnight prior to admission. The
temperature that evening was 104°F ; the next morning 103°4F ;
the bowels loose during the night. Evening temperature 103°F.
3rd February. — Morning temperature 101°4F. Four liquid, thin stools
during the night. Evening temperature 104°4F. Subsultus tendinum and
delirium. During the night the evacuations were frequent and involuntary,
the breathing became hurried, and she died at 2 a.m. on the 4th February.
No eruption was observed on the body either during life or at the post
mortem examination.

103. The lower end of the ileum exhibiting a cicatricial condition of
the mucous membrane, probably from byegone typhoid or
enteric fever. The cicatrices are situated opposite the attach-
ment of the mesentery, and in the position occupied normally
by the patches of Peyer, which structures, however, are seen to
have almost completely disappeared. The cicatrices are “ starred”
and thin, exhibit no morbid deposit or infiltration, and produce
very little, if any, puckering and contraction of the bowel.
The general mucous membrane of the latter is thinned, and all
its coats are atrophied.

The specimen was taken from a case of haemorrhagic apoplexy, a
Hindu (male), aged 57. The attack was sudden, and the
patient died (hemiplegic and insensible) seventeen days after.
No history was recorded of his having suffered from bowel
disease.

104. 'fhe lower third of the ileum and a portion of the large intestine.
Throughout the ileum all the patches of Peyer, and numbers
ot the solitary follicles, are seen distinctly raised and prominent.
The surfaces of the patches are in parts soft, pulpy, highly vascular
(in the recent state), but unbroken ; in others, irregular ulcers,
varying in size, appear upon these surfaces ; and in others, again’
the whole of a patch has sloughed or exfoliated, leaving only a
thin stratum of the transverse muscular coat and peritoneum at
its base. The ulceration becomes more and more marked as the
ileo-coecal valve is approached. The greater portion of this valve,
especially its ileac half, and the mucous membrane for about two
inches above it, are extensively ulcerated, and present an irregular
deeply eroded appearance.

The destructive process throughout is more or less specially confined to
the patches of Peyer. The outlines of the ulcers, and their lon<»
diameters running in the longitudinal axis of the gut render
this very evident.

306

TYPHOID ULCERATION OF INTESTINE, [series ix.

In the large intestine the solitary glands are diffusely affected. They
are raised, prominent, tumefied, and vascular ; each about the
size of a split-pea. Some are entire, but the majority appear
to have undergone ulceration. The ulcers are small, oval or
rounded, and mostly superficial.

Both the tumefied and ulcerated patches in the ileum were, in the recent
state, surrounded by bright vascular zones of congested blood vessels, and
the general surface of the mucous membrane was abnormally vascular.
In the large intestine there was slight vascularity of the mucous surface
immediately around the small ulcers, &c., above described, but the rest of
the bowel was pale.

The spleen was large, dark, and soft. The liver also soft, bile-stained, of a pale,
chrome-yellow colour. The mesenteric glands were enlarged, tumefied
and hyperannic, (see prep. No. 240). The patient, a Bengali (Hindu)
female, aged 22, was admitted into the hospital on the 3rd June 1873, with
marked '’symptoms of typhoid or enteric fever. It was said to be
the ninth day of the fever. Her condition on admission was as follows : “ She
was delirious ; there was subsultus tend inum ; the pupils widely dilated,
and the conjunctiva} jaundiced. Lips and teeth covered with sordes.
Tongue dry. The bowels on admission were constipated, but the next
day and subsequently, she had constant and obstinate diarihcea. fhe
abdomen was tympanitic; much pain on pressure, particularly over the
ricrht iliac fossa. Urine passed freely until the twelfth day of the disease,
when a catheter had to be used. The urine thus removed was slightly acid
and albuminous. She sank into a deep collapse, and died on the fourteenth
day The highest temperature was 105°F. on the evening of the (alleged)
tenth day, and the lowest 95° F. on the fourteenth day.”

The specimen is chiefly interesting as illustrative of the occasional
extension or occurrence of lesions in the large intestine in
typhoid or enteric fever, which are quite as characteristic and
distinctive as those usually limited to the smaller bowel.

105. Typhoid ulceration of the large intestine. The preparation
consists of the ascending colon of a European soldier (Private
W. West, aged 27, H. M.’s 2-2nd Regiment, stationed at Bareilly),
exhibiting a series of small, round or oval ulcers, varying in size
from a split-pea to a two-anna (three-penny) piece. They have
rather sharply defined margins, overlapping slightly . the sub-
mucous coat, while their bases are formed, in the majority, by
the muscular, and in a few, by the peritoneal coat only. They
are irregularly distributed, and not by any means confined to the
transverse folds of the bowel. The general mucous membrane
presented in the fresh state a highly congested purplish
condition.

The patient was admitted into hospital on the 14th May 1878, during an epidemic
of typhoid or enteric fever (in the regiment), and died on the of 9th Jui .
There was a high range of temperature throughout, and very severe
diarrhoea, the latter persisting to the end, and becoming at last involuntary.
The stools are described as “ pea-soupy ” and “ characteristic.”

After death, the duodenum and jejunum presented nothing remarkable. The 'J^e
of the ileum, and chiefly its lower half, was in a state of intense congestion,
of a bright purple colour. There was no prominence or ulceration otw
glandular structures, but there were a few small, superficial, recent -looKing
ulcers on the ileo-ccccal valve.

SEUIES IX.]

DYSENTEKY.

307

(See further, Indian Medical Gazette, vol. XIII, 1878, p. 30(5.)
( Presented Assistant Apothecary J. K. Massey, H. M. s 2-2nd
Queens, Bareilly.)

106. A preparation illustrating the early stage of infarction oi the
solitary glands in dysentery. The portion of bowel preserved
is the sigmoid flexure of the colon. — From a native boy, aged 11
years. There is great prominence and enlargement oi the
solitary follicles, which are distended with a clear jelly-like
secretion.

Sections made through the swollen glands exhibit, under the microscope, a highly
mucoid fluid, faintly granular throughout, in which are suspended numerous
nuclei, a few blood-cells, and numbers of round, granular cells (exudation
corpuscles), with delicate filaments of fibrin. (The columnar epithelium
normally covering the mucous surface of these glands seems to be almost
entirely detached, or, at any rate, so loosened, that when sections are
made the cells fall away from the basement membrane, and are only found
in groups of three or four around the margins of the section. The
submucous capillaries are greatly enlarged, varicose, and congested.

107. The descending colon, sigmoid flexure, and rectum of a Mahom-
edan boy, aged 12 years, who died from acute catarrhal dysen-
tery. The condition of the bowel is extremely characteristic of
the early stage of the disease. The mucous membrane is rough-
looking from much desquamation of epithelium, and, in parts,
superficially eroded and ulcerated ; while the glandular structures
(solitary follicles) are much enlarged, swollen and prominent.
They project from the surface, and are filled with opaque mucoid
secretion. The latter may also be observed to exude in small
fiocculent masses from such of the follicles as have partially or
completely ruptured. All the coats of the bowel are abnormally
thickened, and, in the recent state, were abnormally vascular and
congested, — particularly the mucous and submucous tissues.

108. “ Colon of a native, aged thirty-five, who died from subacute
dysentery on the sixth day. The gut is inverted. There are
numerous ulcers of various sizes and shapes seen along the
whole extent of the canal. None of the sloughs have been
thrown off. There is a fleecy appearance about the mucous
membrane from the exudation material.” (Ewart.) ( Presented
hj Dr. J. Long of Seebsagur.)

109. “ Large intestine of a native male patient who died of ecchy-

motic dysentery, showing the mucous membrane thickly covered
with ulcers, each surrounded by an ecchymosed ring.” (Colies.)
A good specimen of acute catarrhal dysentery. The ulcers are
small but very numerous. Several are deep enough to expose
the muscular coat ; the majority, however, only reach into the
submucous tissue ( Presented by Professor Chuckerbutty.)

110. The whole of the large intestine of a native boy, aged seven years,
who was admitted into hospital in a moribund condition, suffer-
ing from acute dysentery.

The mucous membrane of the whole of the gut is thickened, brightly
injected (in fresh state), and covered with innumerable recent
ulcers. Those in the coecum, ascending and transverse colon are

SOS

ACUTE DYSENTERY.

[series IX.

more or less distinctly rounded, their bases covered with soft
yellowish sloughs, their margins raised and swollen. Where
sloughs have separated, the muscular coat is freely exposed. In
the descending colon, sigmoid flexure and rectum, the ulcers are
larger, more irregular in shape, form an almost continuous
series in the last six inches of the bowel, and the muscular coat
is not only laid bare, but itself is the seat of secondary ulcer-
ation and softening. In the lowest part of the rectum some
yellowish, granular inflammatory effusion (lymph) covered the
ulcerated surfaces. ( See further, “Medical Post-mortem Records, if
vol. I, 1874, pp. 337-38.)

111. “ Large intestine of Gobindo, aged 50, admitted with dysentery
of twenty days’ standing. He passed several sloughs, but
was getting on well when, owing to an error in diet, the disease
relapsed, and the patient died of bronchitis and pneumonia.

The intestine is full of ulcers, some of which have almost healed ; others
are clean, but devoid of granulations. At the lower end of the
gut are several granulating ulcers.” (Colies.)

This specimen affords a good illustration of the manner in which repair is effected
after acute dysentry. J. F. P. McC.

112. Acute dysentery. “ An ulcerated coecum. By far the greater
part of the mucous membrane has been destroyed. In some
places the disintegration has advanced down to the peritoneum
which forms the floor of the ulcers ; in others, it has only pro-
ceeded down to the muscular coat, which is enormously thickened
from implication in inflammatory disease. In the vicinity of the
appendix vermiformis, the intestinal wall is almost half an inch
in thickness. There are numerous shreds of undetached slough,
or perished portions of the mucous and muscular tunics.”
(Ewart.)

113. A preparation showing perforation of the coecum, the result of
dysenteric ulceration. The coecum and a portion of the ascend-
ing colon are preserved, and exhibit large, transversely placed,
deep ulcers, exposing the muscular coat. In the coecum itself
this process (ulceration) is most marked, affects almost uniformly
the whole inner surface, and the coecal aspect of the ileo-coecal
valve. The perforation is about as large as a rupee (florin), and
has thin shreddy margins. The ileum is seen to have remained
unaffected. No history.

114. E xtensive and deep ulceration of the coecum and ascending
colon. The ulcers are large, transversely placed, and either
covered by semi-detached flocculent sloughs, or are bare, exposing
freely the muscular coat. The submucous tissues generally are
much thickened.

115. Acute sloughing dysentery, involving principally the coecum,
ascending and transverse colon. The coecum exhibits a ragged
tattered condition, and in parts has become so thinned from the
rapid destruction of its coats that the peritoneal investment
alone remains, and even this has given way at several points in the
removal of the intestine post mortem . Occupying the first six

6EKIES IX.]

ACUTE DYSENTERY.

309

inches of the ascending colon is a partially detached tubular
slough of the whole of the mucous membrane, and throughout
the transverse colon are numerous serpiginious ulcers of irregular
outline, with thickened and shreddy margins. ( Presented by
Professor Edward Goodeve.)

116. A portion of the sigmoid flexure “ from a native patient who died
of the ‘ carbuncular form’ of dysentery. The submucous cellular
tissue is dead and infiltrated with pus. Great thickening of
all the coats of the bowel exists. They are very distinct, and
may be separated by means of a knife.”

A good specimen of acute catarrho-flbrinous dysentery. ( Presented by
Professor Chuckerbutty.)

117. “ Large intestine of a native male patient, who died of gangrenous
dysentery. Shows large ulcers, to some of which black foetid
sloughs are still adhering, and from others of which they have
separated. One such slough involves the entire thickness of the
mucous membrane for the whole circumference of the gut.”
(Colies.) ( Presented by Professor Chuckerbutty.)

118. “ The coecum and ascending colon of an aged up-country Hindu,
admitted into the hospital on the 14th December 1S66, in a
pulseless and moribund condition, with a dysentery of fourteen
days’ standing. The stools were very offensive, — had a cadaveric
smell. He died on the morning of the 21st instant.

The specimen shows gangrenous ulceration occupying a large portion
of the coecum. Such sloughs as have not separated are floated
out, and are of a dark (almost black) appearance.* One of them
has extended right across the gut, so as to embrace its whole
diameter. Along the course of the ascending colon there are
innumerable ulcers, varying in size from that of a millet-seed to
that of a hazelnut ; and, just .at the hepatic flexure, there is one
large gangrenous ulcer, two inches in length and one in breadth,
the longer diameter running transversely.

“ On submitting to microscopical examination a portion of a slough from a small
ulcer, it was observed to contain nothing hut fibrous and areolar tissue,
interspersed with granules which did not disappear on the application of
ether, hence probably of an albuminous composition. JNo pus-corpuscles
were seen,

“ 0n examining a specimen from one of the dark coloured sloughs attached to the
gangrenous liberations of the coecum, it was found to consist of altered
areolar tissue, the relics of the follicles of Lieberkuhn, which were cram-
med with granular matter of a somewhat yellowish colour, and which did
not disappear on the application of ether. Other portions of this pigment
'ure of darker colour, l he former, the yellowish pigment, is probably the
b'«n °f blood etlused during the sloughing process.” (Chucker-

119. Acute sloughing dysentery. The large intestine of a native male
patient, who died in hospital. The whole of the bowel, from
tne coecum to the anus, presents an almost continuous series of
unhealthy sloughy-looking ulcers affecting the mucous surface.

* T!u8 dwc^ounition has been lost owing to long maceration of the specimen in spirit.

310

ACUTE FIBRINOUS DYSENTERY. [series ix.

The ulcers run in a transverse direction, are of various sizes and
depths, a great many reach the muscular coat, and all, in the
recent state, were surrounded by swollen and highly congested
mucous membrane. The peritoneal surface of the gut also showed
dark-purplish vascularity in patches. The splenic flexure of
the colon was united to the diaphragm and, at this spot, a deep
ulcer had very nearly perforated. There is much inflammatory
thickening of all the coats of the bowel.

120. The ccecum, ascending colon, and a portion of the transverse colon

with recent acute dysenteric ulceration. The rest of the large
intestine presented even a greater amount of disease. All the
coats of the bowel are seen much thickened and swollen, the
calibre of the gut contracted, and the mucous surface covered
with large irregular-outlined ulcers, reaching the muscular coat,
which, in turn, is observed to be eroded. The margins of the
ulcers are thick and oedematous, their bases soft and shreddy, or
presenting a peculiar mammillated appearance. The solitary
follicles,— in such portions of the mucous membrane as remain
unulcerated — stand out prominently, and are much swollen and
hypertrophied, (acute catarrho-fibrinous dysentery).— From a
native male patient, aged 32. #

121. Coecum (inverted) showing the effects of localised acute in-
flammation (typhlitis). The entire mucous membrane of this
portion of the bowel presents a soft, shreddy, gangrenous con-
dition, but is still attached to the subjacent tissues. — From a
native female, aged 20, who died in hospital. (See fuither,
“ Medical Post-movlein Records,” vol. II, 1878, pp. 681-82.)

122. The greater part of the large intestine in a state of acute crupous
or fibrinous dysentery. "Very little normal mucous membiane
exists ; the whole surface is covered with large transversely-
placed ulcers, the margins of which show inflammatory thicken-
ing, and their surfaces are covered by recent granular 1) mph,
so as to present a velvety or somewhat villous appearance.

123- A portion of the sigmoid flexure from a case of acute dysenteiy,
showing extensive and uninterrupted ulceration of the mucous
membrane, which presents also a coarsely granular or villous
appearance from the presence of an abundant inflammatory
(crupous) exudation. The submucous tissues are much swollen
and tumefied ; the whole gut greatly thickened, and its channel
or calibre contracted.

124. Acute fibrinous or crupous dysentery, extending into the small

from the large intestine. The lower four inches of the ileum,
the coecum, and a portion of the colon, are preserved.

The mucous membrane of the large gut is seen to be raised in huge
transverse folds, of great thickness and solidarity from sub-
mucous fibrinous effusion and vascular congestion, while the
surface is commencing to be ulcerated, and is also invested iy
a little recent granular lymph. These changes, by direct
continuity of structure, have passed beyond the lleo-coecal va
into the small intestine.

series IX.] ACUTE FIBRINOUS DYSENTERY.

311

125- The eight inches of the ileum, with the coecum, and a
portion of the ascending colon, showing recent acute dysenteric
changes. The specimen is preserved to illustrate the extension
of the disease from the large intestine (which was throughout
and uniformly affected) into the small. In the latter, more-
over, the glandular structures are not by preference selected ;
one Peyer’s patch, in fact, a little above the ileo-coecal valve,
is conspicuously free from ulceration. The mucous membrane
generally is highly vascular and ecchymosed (in the fresh
state), deeply furrowed by transverse ulcers, to the surfaces
of which small sloughs, and soft, recent, exudation material
(lymph) are adherent, giving a peculiar and characteristically
granular appearance (crupous or fibrinous dysentery). The
subject was a native female, aged 35, who (lied on the fifth
day after childbirth. ( Obstetric Post-mortem Records, vol. I,
1S7G, pp. 263-64.)

126. A portion of the descending colon showing abnormal vas-
cularity with fibrinous exudation and superficial ulceration of the
mucous membrane. All the coats of the bowel are thickened,
and the calibre of its channel contracted. There was sloughing
ulceration of the whole of the coecum and of a portion of the
ascending colon ; also multiple abscesses (pyaemic) in the liver.
From a native male (Mahomedan) who died in hospital.
(See further, “ Medical Post-mortem Records,” vol, II, 1S78,
pp. 673-74.)

127. The whole of the large intestine, with about six inches of the
ileum, exhibiting very characteristically the morbid anatomy
of acute fibrinous dysentery. The whole of the gut, from the
coecum to the anus, is enormously thickened ; the mucous
surface thrown into huge transverse folds ; the submucous
tissue swollen and oedematous. The mucous membrane is red and
raw-looking, covered Avith recent lymph, forming a granular and
almost uniform layer, and extending upAvards from the coecum
into the last six inches of the ileum. — From a native male
(Mahomedan), aged 20, who died in hospital. ( See further,
“ Medical Post-mortem Records,” vol. Ill, 1879, pp. 161-62.)

128. Acute fibrinous or crupous dysentery. The whole of the large
intestine is diseased. The mucous membrane is thrown into
large, solid, firm, transverse folds, Avith deep furroAVs betAveen
them, Avhile the surfaces of the ridges are covered Avith agranular
fibrinous exudation, Avhich has a dusky-red or greenish colour.
The submucous tissues are all much swollen and rigid, and
the calibre of the gut greatly reduced. — From a Hindu male,
aged 32, who died in hospital. ( See further, “ Medical Post-
mortem Records,” vol. Ill, 1879, pp. 221-22.)

129. A preparation exhibiting the effects of chronic dysenteric ulcer-
ation of the sigmoid flexure and rectum. The ulcers are laro-e
irregular-outlined, and freely expose the muscular coat. The
Avails of the intestine are throughout abnormally thinned, in parts
(piite semi-transparent.

312

CHRONIC DYSENTERY.

[series IX.

130. A portion of the colon from a case of chronic dysentery. The
bowel has been inverted so as to exhibit the mucous surface,
which is seen to he covered with innumerable, round, oval, and
irregular-shaped ulcers. They are shallow and superficial-looking,
yet expose the muscular coat. All the tunics of the gut present
a thinned and greatly atrophied condition. ( Presented by Dr.
R. Shaw, of Agra.)

131. “ A portion of the colon of a Madras convict, who died from
chronic dysentery at Singapore.” The mucous membrane has a
peculiar worm-eaten appearance from the presence of innumerable,
shallow, irregular-outlined ulcers and minute pittings over the
entire surface. The coats of the intestine generally are a good
deal atrophied and attenuated. ( Presented by Surgeon Oxley,
of Singapore.)

132. “ The coecum, colon, and sigmoid, illustrating the effects of
chronic follicular dysentery. The mucous membrane contains
a great number of circular or oval ulcers, some of which have
joined each other by mutual extension. Some of the ulcers have
healed by granulation and cicatrization, and are now covered by
white contracting and glistening cicatrices ; others are closing
and contracting and advancing to reparation, which is still
incomplete. There is general diffused thickening of the mucous
muscular and peritoneal tunics. The ulcerative disease is so
extensive that there is very little healthy surface to be discover-
ed.” (Ewart.)

133. A preparation showing extensive sloughing (dysenteric) of the
mucous membrane of the whole of the rectum and sigmoid
flexure of the colon, some of which may be seen hanging out
of the anus in the form of a tubular gangrenous mass. The
muscular and peritoneal coats of the rectum are greatly thick-
ened, of almost cartilagenous density. Those of the sigmoid
flexure are thinner, and, at one spot, present a ragged, tattered
condition. Perforation here was only prevented by the abnor-
mal thickness of the peritoneal coat, a portion of which has
been dissected off the surface of the bowel in order to display
this change more effectively. ( Presented by Dr. J. Davis, of
Tezpore, Assam.)

134. The whole of the large intestine, exhibiting an almost continuous
series of deep, irregular-outlined ulcers, most marked or exten-
sive in the coecum and ascending colon, and then in the rectum.
In these parts the surface has quite a honey-combed appearance,
and scarcely any normal mucous membrane exists, so complete
is the disorganisation of the bowel. The muscular coat is
throughout either exposed or thickened, and the peritoneal tunic
is also preternaturally opaque. — From a European of intemper-
ate habits. ( Presented by Dr. Oxley, of Singapore.)

135. Chronic dysenteric ulceration of the large intestine. The mucous
surface is seen to be covered with innumerable, small, more or
less rounded, pitted ulcers, giving a honey-combed appearance
to the bowel. The majority of the ulcers reach the submucous
or muscular coat. The latter is throughout hypertrophied, and

SEEIE9 IX.]

CHRONIC DYSENTERY.

313

the calibre of the gut narrowed. ( Presented by Dr. Chucker-
butty.)

136. Chronic dysentery. A portion of the large intestine showing
extensive ulceration of the mucous and submucous tissues.
The ulcers are exceedingly numerous, are small and pitted, and
give a peculiar reticulated appearance to the inner surface of
the bowel. The whole of the gut is thinned and dilated.

137. Chronic dysenteric ulceration of the whole of the rectum. The
ulcers are mostly small and superficial, with clearly defined
sharp margins. They are exceedingly numerous, leaving scarcely
any intervening mucous membrane, and that which does exist
is thickened, rigid, and shows, in parts, swollen, infiltrated, and
infarcted solitary follicles. The disease seems to terminate
abruptly at the sigmoid flexure.

138. A portion of the large intestine of a European female, who died
from chronic dysentery. The gut is throughout thickened and
its calibre reduced. The mucous membrane is covered with
small and large ulcers (the latter indicated by black glass-
rods). These are either superficial and pitted, or deep, exposing
the muscular coat, and with rigid, thickened margins. Some
are covered by granulations, indicative of an attempt at repair,
while in other parts, again, are large cicatrices, the results of the
healing of these ulcers. At such spots the mucous surface is
seen drawn in and puckered in a most remarkable manner.

139. Chronic dysenteric ulceration of the rectum and sigmoid flexure,
with much dark pigmentation of the gut. The whole of the
mucous membrane of this portion of the bowel is involved, is
covered with innumerable small, pitted, and eroded-looking
ulcers, having pigmented margins and bases. The submucous
tissues, especially the muscular coat, are greatly hypertrophied.

140. Very extensive chronic dysenteric ulceration of the large intes-
tine. From a native female •who had suffered from the disease
for about four months. The original mucous membrane, thick-
ened and altered in appearance, is seen to form irregular-shaped
patches and small islands surrounded and separated by ulcers
which are of varying size, but deep, and freely expose the
muscular coat. The margins of the ulcers are ragged and under-
mined, their surfaces smooth, or, in parts, a little rough and
shreddy from the extension of the ulcerative process to the
muscular coat. The disease is most diffuse in character.

i 141. A portion of the large intestine (colon) preserved to illustrate
the mode of healing and cicatrisation of dysenteric ulcers, and
the large deposit of dark pigment in and around these, in
fact, infiltrating the mucous membrane generally ; — evidences of
long-standing or chronic dysentery. The walls of the intestine
are also considerably hypertrophied.— -From a European (male)
patient, who died in hospital. ( See further, “ Medical Post-mor-
tem Records,” vol. Ill, pp. 1-2.)

142. The sigmoid flexure and rectum showing small, chronic, par.
tially healed, and very darkly pigmented dysenteric ulcerations

314

PERFORATION OF SMALL INTESTINE. [series ix.

of the mucous membrane, and much thickening of all the
coats of the bowel, with contraction or narrowing of its
calibre.— From a native male, aged 32, who died in hospital.

143. The transverse colon of native male (Mahomedan) patient,
aged 32, showing several healed dysenteric ulcers. These were
found irregularly distributed throughout the whole of the large
intestine, and present the form of darkly pigmented puckered
cicatrices. All the coats ot the bowel are somewhat thickened.
(See further, “Medical Post-mortem Records,” vol 111,1880,
pp. 723-21.)

144. Perforating ulcer of the deodenum, situated immediately below
the pyloric ring. The perforation is as large as a crow-quill,
and elliptical in shape. It is sharply defined on the peritoneal
aspect of the bowel, and here surrounded by a thin circle of
recent lymph. On the inner surface of the gut the ulcer is
somewhat stellate in form, its edges well defined, but bevelled
down to the perforated spot. — From a sepoy (Hindu), who died
in the regimental hospital, 22nd Native Infantry, Alipore.
(Presented by Surgeon II. A. C. Grey, 22nd N. I., Alipore.)

145. A portion of the lower end of the jejunum. At the upper
part of the preparation is seen a transversely placed cicatrix,
the result, apparently, of the healing of an old ulcer; lower down
there is a complete perforation through all the coats of the
intestine, the peritoneal surface of which is much thickened from
recent deposit of lymph. The perforation is just large enough to
admit a crow-quill. The patient, a native male, aged 30, died
from acute peritonitis. (See further, “ Medical Post-mortem
Records,” vol. II, 1876, pp. 181-82.)

146. A portion of the lower end of the jejunum showing two
transversely placed broad ulcers, with much contraction of
the bowel in these situations, and perforation of the same
through the base of the upper ulcer, — an opening sufficiently
large to admit a pencil,— through which fcecal extravasation took
place into the peritoneal cavity, and gave rise to acute general
peritonitis, from which the patient died.

The margins of the ulcers are abruptly defined, a little indurated, and
somewhat pale and anaemic. Their bases are slightly mammil-
lated. A distinct cicatricial line is observed along the lower
margin of each ulcer, where the bowel also is much puckered
and drawn in, and its channel so much reduced as to allow with
some difficulty the passage of a finger.

The appearance of the bowel is that of old cicatrisation leading to
constriction, and of secondary ulceration (probably tubercular)
attacking the cicatrix, and commencing to spread. — From a
native male, aged 40, admitted moribund, with great distension
of the abdomen, much pain and uniform tenderness ; frequent
vomiting, &e. (See further, “ Medical Post-mortem Records,”
vol. Ill, 1880, pp. 477-78.)

series ix.] PERFORATION OF LARGE INTESTINE. 315

147. A portion of the ileum showing a large perforation, involving

nearly the whole of the transverse diameter of the gut, and
apparently occupying the situation of an old ulcer. On the
inner surface of the bowel the mucous membrane is thickened
and eroded ; on the outer, the peritoneal coat is covered by
recent shreddy or flaky lymph. — “ From a native female, aged
27, who had been suffering for a long time from diarrhoea,
and who died suddenly, with symptoms of perforation and
peritonitis.” There was also a small perforation of the largo
intestine, — ( see prep. No. 148) ( Presentedby Dr. Ii. Stevens.)

148. A smaller, sharply-defined perforation of the transverse colon, of

about the diameter of a crow-quill, from the same case, {see prep.
147). The surrounding mucous membrane is enormously

thickened, raised into prominent folds, and superficially eroded
and rough-looking.

149. “ A portion of the duodenum which has been perforated by a
lumbricus. The cephalic extremity of the entozoon is lying in
the cavity of the gut, protruding as if from the finger of a
glove. The external and internal margins of the aperture
are even and glistening. On both aspects the mucous mem-
brane is elongated and loosely wrinkled ” (Ewart.)

150- A portion of the ileum (about nine inches above the ileo-coecal
valve), showing perforation of the bowel in two situations, about
six inches apart, by round-worms {A. lumbricoides). Two of
these worms are seen (as found) partially protruding through
the walls of the intestine ; a third lay within the gut, between
the perforations ; and a fourth was discovered free in the
peritoneal cavity, close to the injured bowel. There was acute
general peritonitis, and about forty ounces of mixed foecal and
inflammatory fluid in the peritoneal cavity. — From a Mahomedan
male, aged 18, who died in hospital. (“ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 103-4.)

151. A preparation of the pyloric end of the stomach and upper half
of the duodenum, — the latter a good deal thinned, and perforated
by a round-worm (A. lumbricoides). The patient, a native
female, aged 30, died from acute general peritonitis, the result
of this accident. (“ Medical Post-mortem Records,” vol. II
1878, pp. 473-74.)

152. The coecum and ascending colon showing perforation of the
latter in two places by lumbrici. The mucous surface of the
bowel presents numerous, apparently indolent, and chronic ulcer-
ations, and the wall3 are generally thin and readily lacerable, —
conditions which no doubt account for their ready perforation
by the entozoa.

153. “A slough, ten inches long, expelled from the large intestine
during a fatal attack of dysentery. Thie consists, in great
measure, of the mucous membrane with portions of the muscular
tunic. At the upper part of the specimen about half of the-
circumference of the mucous • membrane has been completely
detached, but at the lower three inches the whole of this tunic

316

DYSENTERIC TUBULAR SLOUGHS.

[SERIES IX.

has become separated. The slough is more or less perforated
in the situations where the ulcers originally existed.” (Ewart.)

154. “A large slough from the intestine. A portion of it protruded
from the rectum two or three days before it was evacuated. The
central part of the slough seems to consist of the entire circum-
ference of the mucous membrane and submucous areolar tissue.
The terminal parts are of the same composition, but the canal is
incompletely represented.” (Ewart.) ( Presented by Professor
Edward Goodeve.)

155. A dysenteric slough, measuring about three feet. “Four inches
and a half of it protruded from the rectum prior to death.”

* * # “ The lower end of the sloughed mucous

membrane is attached at its inferior end about an inch from
the anus.” (Ewart.) {Presented by Professor Edward Goodeve.)

156. “ Two portions of mucous membrane perforated in several places
by penetrating ulcers, and discharged by a patient suffering from
dysentery on the ninth day of the disease.” (Ewart.)

157. “ A large laminated dysenteric slough, six inches long and two
inches wide, from the colon of a native male, Ram Singh. It
involves all the thickness of the mucous membrane. On one
surface is seen the epithelial lining, partially detached ; the other
is shaggy with shreds of submucous tissue.” (Colies.)

158. “Tubular slough from the large intestine of Joseph C — .,
admitted with obstinate constipation and pain in the left iliac
region. Intussusception of the sigmoid flexure was diagnosed.
After a feeling as if something had given way an immense
accumulation of fceces was passed, and afterwards the slough,
which has been preserved. It consists of the mucous, submu-
cous, and muscular coats of part of the large intestine, probably —
from the absence of longitudinal bands— of the lower end of
the sigmoid flexure or upper end of the rectum.” (Colies.)
(. Presented by Professor Chuckerbutty.)

159. “ Another tubular slough from the same patient ” as prep.
158. It is five inches in length, involves the whole circumfer-
ence of the bowel, and consists of the mucous and submucous
coats cast oft en masse.

160. A slough twenty-one inches in length and embracing the whole
calibre of the bowel (colon), passed by a European, Peter P— .,
admitted into hospital with acute dysentery.

161- Thick, fleshy, pus-inliltrated sloughs, from a case of acute
dysentery,— a European, aged 25.

162. Epithelial or pellicular sloughs from a case of acute dysentery
(European male). Disease of about seventeen days’ standing.

These delicate sloughs were of pearly whiteness when first passed,
have become brownish after preservation in spirit. Are smooth
and velvety on one side, ribbed on the other, the latter being the
attached, the former the free surface.

Under the microscope the superficial portion is seen to consist of a densely granular
basis-substance which is crowded with (1) epithelial cells, large and round, a
few columnar, — all swollen, dark, and undergoing molecular disintegration;
(2) smaller, round, granular cells — “ mucus” or “ gland cells;” (3) fat-crystals

series ix.] INTUSSUSCEPTION OE THE BOWEL. 317

(margarine); (4) a few red and moro white blood-cells; and (5) much
granular and molecular fat. The deeper layers show, here and there, a
trace of fibrillation, and even a few delicate elastic tissue fibres ; a more
transparent but highly and minutely molecular basis-substance, in which
are found numerous round granular cells (leucocytes), in clusters, or
assuming a linear arrangement; some granular cylindrical or even tailed
epithelial cells, and a few blood corpuscles. These pellicular sloughs are
therefore chiefly composed of shred and altered epithelium, with
exudation or inflammatory material.

163. A dysenteric slough, about 18 inches in length, tubular in shape,
and comprising the whole thickness of the mucous membrane of
the rectum and sigmoid flexure. It was found adherent only to
the lower part of the rectum ; above this, had been quite detached.
Similar but smaller sloughs occupied the rest of the large
intestine, which from coecum to anus presented one mass of dark,
gangrenous, dysenteric ulceration. — From a native male (Hindu),
aged 35, who died in hospital.

164. A tubular dysenteric slough, about 18 inches in length, from the
coecum and ascending colon. It was found on post mortem,
examination, lying loose for the greater part of its extent, in the
channel of the gut, but still adherent slightly in the coecum.
From a native female, aged 26. The case terminated fatally
from acute peritonitis, the result of perforation. The opening
consisted of a mere slit, two or three lines in length, situated at
the hepatic flexure, and in close proximity to this slough. The
peritoneal coat, much thinned and stretched, had given way.

165. Three portions of the small intestine exhibiting five intussuscep-
tions of the gut at short intervals. No history of the case has
been preserved, but, judging from the absence of all inflammatory-
changes, the invaginations were probably post mortem. ( Presented
by Dr. Lyons, of liohtuk.)

166. “ Intussusception of the coecum into the ascending colon, carrying
with it the lower end of the ileum. A portion of the ulcerated
and gangrenous gut invaginated is exposed. About four inches
of the ileum, at the point of invagination, is in situ." (Ewart.)
( Presented by Professor Norman Chevers.)

1 167. The invaginated portion of a huge intussusception of the coecum
and part of the ileum into the ascending colon. The whole of
the inverted mucous membrane now exposed is extensively
ulcerated (dysenteric). The ulcers in the lower half of the prep-
aration are large and deep, with shreddy surfaces ■ in the upper
half are small, pitted, round or oval.

168. Intussusception of the coecum and adjacent portion of the ileum
into the ascending colon. The whole of the latter “ was dis-
placed, and directed from the right iliac fossa, upwards, towards
the left side, thereby causing a corresponding displacement of
the transverse colon, which was almost doubled upon itself
lying along the left side ; the convexity of the curve looking
downwards towards the sigmoid flexure.” (Chuckerbutty.) —
From a native male patient, Shetul, aged 45, who died from
“ inaction of the bowels and exhaustion nineteen days after the

318

INTUSSUSCEPTION OF THE BOWEL. [series ix.

first symptoms of internal strangulation appeared. ’ (Presented
by Professor Chuck erbutty.)

169. A portion of the ileum of a native male patient, aged 50, who
died from haemorrhagic brain-softening (old apoplexy with hemi-
plegia). There is an intussusception of the bowel from above
downwards, about the size and shape of an ordinary sausage.
About four inches above this part a small polypoid growth is
seen, attached to the inner sui’face ol the bowel, and invested by
the mucous membrane, which, over a small circumscribed space
at the fundus of the growth, has sloughed. The polypus is
about the size of an English plum.

The intussusception was not indicated by any symptoms during life, and
no inflammatory changes are observed in the invaginated poition
of the intestine. It appears, therefore, to have taken place, in the
articulo mortis , or is purely post mortem , and may be attributed,
in either case, to defective innervation, loss of tone, and peiveited
peristaltic action ; the polypoid growth, moreover, may possibly
have been the immediately exciting or predisposing cause of the

170.

invagination. . .

Intussusception of a portion of the ileum and the whole oi the

coecum into the ascending colon. The patient, a native female,
a"ed 25, by occupation a maid-servant, was admitted into hospital
in a moribund condition. There was a history of dysentery
with fever of twenty-two days’ duration. She was extremely
weak and emaciated, and died within 30 hours. Symptom* indic-
ative of perforation of the bowel and peritonitis were observed
during the last twelve hours of her life. On post-mortem examin-
ation there was great vascularity and injection of the entire
peritoneum, with much effusion of recent lymph between the
coils of the intestine. Just below tne liver, in the right lumbar
region, a large purplish tumefaction was found the size of one s
fist It protruded through a rent in the softened and shreddy
anterior wall of the ascending colon. Examined more closely,
this was found (as in the preparation) to be an intussusception
of the ileum with the coecum into the ascending colon No
inflammatory changes were observed in the invaginated bower,
and there were no symptoms of tumour or obstruction during
life • so that the rupture of the colon and the intussusception. ot
the coecum and ileum must have taken place almost, it not quite
simultaneously, and only shortly beiore death. .

Almost the whole oi the mucous membrane ol the large intestmo wo
diseased, covered with large sloughing ulcers ; and the base of
one such ulcer had given way, producing the rent through which
a portion of the invaginated bowel protruded, as deocnbcd
above. (See further, “ Medical Post-mortem Records, vol. I,

An^ntassu^ceptiL oi the small intestine The preparation
exhibits a portion of the ileum with several transversely placed
puckered, and partially cicatrised ulcers producing nariowmg
and contraction of the bowel in these situations, and at t
lower part, (about twelve inches above the ileo-coeeal valve),

171.

series ix.] INTERNAL STRANGULATION OF THE ROWEL. 319

172.

a gangrenous invagination of the intestine, about six inches in
length. The peritoneal coat of the outer portion is deeply con-
gested, and a considerable deposit of lymph exists between
it and the invaginated portion, but the latter has not yet
separated.

Numerous tubercular ulcers were distributed over the mucous membrane
of the whole of the small intestine. — From a native male,
aged 27, who died in hospital with well-marked symptoms of
internal (enteric) strangulation. (See further, “ Medical Post-
mortem Records,” vol. II, JS77, pp. 331-32.)

Intussusception of the ccecum with a small portion of the ileum
into the ascending and hepatic flexure of the colon. There was
general peritonitis with the effusion of foeculent fluid into the
abdominal cavity. The invaginated bowel had acquired firm
adhesions with its sheath, but the latter having given way
(sloughed) on one side, foecal extravasation and acute peritonitis
were set up, and proved fatal. The intussuscepted mass is
about a foot in length. Its lower extremity, which reached
the transverse colon, presents a highly gangrenous condition.

The patient, a native male, aged 45, was admitted into hospital with
constipation of six days duration. A. distinct rounded
tumour could be felt in the right hypochondriac region, which
was solid and dull on percussion. Three large enemata were
administered, each bringing away small bits of dry and hard
fceces, but affording no relief. Towards evening symptoms of
collapse set in, and ho died at midnight.

A poition. of the small intestine showing an intussusception
of about six inches of the ileum. From a native male a
sweeper, aged 20. The patient died seven hours after ’the
performance of abdominal section for the relief of the strangulated
gut.. (Presented by Surgeon Shirley Deakin, f.r.c.s., 34th
Native Infantry, Allahabad.)

“Preparation showing strangulation of a knuckle of small intes-
tine by an adventitious band. The strangulated gut is about
the size of a hen’s egg.” (Ewart.) No history.

A portion of the ileum with the coecum. About four inches
above the lleo-coccal valve is a broad pale stripe of thinned and
contracted bowel, about f of an inch wide. At this spot a firm

n?!'01!8! b+!}nd’- t.heiresult’ Probably, of byegone peritonitis, corn-
el1'q*ei/h, 6 intestine, producing complete obstruction. The
whole of the small intestine above this spot was inflated and
distended ; its outline could be seen through the abdominal wall
sausage-like rolls lying transversely beneath

mntv P fC iargf gut, (beW) Was ^itc Elapsed and
;o£ty: Case of a Hindu male, aged 32, who died in hospital.

u o o™rPier, Medical 1 ost-mortem Records,” vol. I DD
139-200.) ’ rr*

aIwnaIfSffa”gulaf,i-“.0f-tH,bowel- Tho Preparation shows
? ■ ? Pf °! \hG fm‘?n intestine (ileum), about six inches in leno-th
(situated about three inches above the ileo-ccecal valve) which
was Strangulated by being forced through a rent In tle great

173.

174.

:175.

176.

320 INTERNAL STRANGULATION OF THE BOWEL, [series ix.

omentum. The latter was unusually developed, thinned, stretch-
ed, and firmly fixed to the lower part of the abdominal wall and
iliac fascke by old peritonitic adhesions. The portions of bowel
on either side of the loop exhibit the effects of the strangulation
upon the rest of the gut, viz., dilatation and distension of the
small intestine above the obstruction, contraction and collapse of
the large intestine below this spot. From a native female,
aged 30.

177- About four inches of the ileum with the ccecum, and a poition
of attached great omentum. About an inch above the ileo-coecal
valve the ileum is seen strangulated by a narrow sti and o the
omentum, and its peritoneal surface here superficially ulceiated
from the tightness of the constriction— From a native male
patient, aged 20, who died in hospital. ( See further, Suigical
Post-mortem Records,” vol. I, 1875, pp. 135-36.)

178 A loop of the ileum, about 18 inches in length, strangulated by
an adventitious fibrous band, probably congenital. It extended
from the mesentery to the anterior abdominal wall on the
right side, a little above and internal to the anterior superior
spine of the ilium. — From a Hindu (male), Poolin, agei 20,
admitted with symptoms of intestinal obstruction, including
stercoraceous vomiting, which had lasted for five days. He died
within twenty-four hours. ( See further, “ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 117-48.)

179 Strangulation of a mass of the small intestine, measuring about
five feet, by fibrous bands in the mesentery. The constriction
was situated about three inches above the ileo-ccecai valve, lhe
laro-e loop of intestine thus obstructed is seen to be quite
collapsed, reduced to less than a third of its normal calibre, and,
in the recent state, showed dark purple venous congestion of the
peritoneal surface. Above this part the small intestine was
found distended with foecal fluid, while the coecum, below con-
tained only a few scyballa, and the rest of the large gut was
contracted and empty.— From a native male, aged oO, a sweeper,
employed in the Medical College Hospital.

180. Strangulated loop of intestine, consisting chiefly of the sigmoid
flexure. The strangulation was due to twisting upon itself o
this portion of the gut immediately above the pelvic brim.
There was general peritonitis. The bowels had been complete y
obstructed for six days.— From a native male, aged oo,who died

in hospital.

181 An enormous volvulus, formed by the sigmoid flexure and lower
part of the descending colon. The site o the twist was at the
pelvic brim, on the left side. The strangulated portion o Antes
tine is extremely distended, its coats greatly stretched and
almost transparent. The peritoneal surface is dark pur]*
colour ; the mesenteric vessels ramifying beneath it were h Wy
varicose, and filled with dark (black) blood. There was general

acute peritonitis.

REEIES IX.]

HERNIA.

321

The obstruction of the bowels had lasted for about fourteen days.
— From a native male, aged 10. j(“ Medical Post-mortem lie-
cords,” vol. II, 1870, pp. 81-82.)

182. A large coil of the intestine, consisting of the sigmoid flexure
and a portion of the descending colon, strangulated b}r a twist upon
itself (volvulus). This portion of the gut was found removed
from its normal position in the left flank, and forced over to the
right side. It constituted (as may be seen from the preparation)
an enormous tumour, distended with gas and containing a little
fcecai fluid. It lay over the small intestine in the hypogastrium,
and reached the right inguinal and lumbar regions. The rectum,
below it, measured about eight inches, and was found collapsed
and empty. The large and small intestine above the strangulated
loop were distended with thin, highly offensive, foeculent fluid
and flatus. Both parietal and visceral layers of the peritoneum
were abnormally vascular, and about four ounces of sero-san-
guineous fluid had collected in the peritoneal cavity, but no
true inflammatory exudation (lymph) existed. — From a native
male, Arroo, aged 25. — ( See further, “ Medical Post-mortem
Records,” vol. I, 1875, pp. 801-2.)

183. Oblique inguinal hernia of the right side. Sac laid open, and
surrounding soft parts preserved. The sac has a thickened
opaque appearance, as if the hernia had been of long standing ;
the internal abdominal ring is wide ; through it there is seen,
protruding into the sac, a considerable mass of omentum. By
way of contrast, the left side of the scrotum has been incised
to show the normal condition of parts as compared with those
on the right. ( Presented by Professor Allan Webb.)

184. “ An oblique inguinal hernia of old standing. The canal is
dilated, so that it easily admits the finger at the entrance of the
internal ring. Its walls are thickened, and it measures upwards
of three inches in length. The sac is about the size of an
orange. Its walls are thickened and indurated.” (Ewart.) The
dissection made shows well the anatomical coverings and rela-
tionships of a hernia of this class.

185. The sac of an inguinal hernia dissected out and laid open to
show its relations to the spermatic cord and testicle. It is
about three inches in length, and reaches to within two inches
of the testicle.

I 186. “ Preparation showing the opened sac of a large inguinal hernia

ol the right side. The interior of the sac is much puckered and
very thick." A section has been made through the healthy
testicle below. Its tunica vaginalis is found quite normal. —
( Presented by Professor R. O’Shauglmessy.)

i 187. An old hernial sac (inguinal) showing great thickening and much
wrinkling or corrugation of its inner surface. The internal ring is
large, easily admitting two fingers. The tunica vaginalis was
found filled with coagulated blood (hannatocele). The testicle is
much compressed and atrophied. All these parts are shown in
■ the preparation. ( Presented by Mr. Vanderstratten.)

322

INGUINAL HERNIA.

[series ix.

188. An old hernial (inguinal) sac of the right side, found on post

mortem examination of a native male patient, aged 35, who
died of acute sloughing of the scrotum, extending to the right
tunica vaginalis. The walls of the sac are thick and leathery.
It descended fully two inches below the external abdominal ring,
and the internal ring was dilated, admitting one finger easily.
The sac contained no intestine, but (see preparation) a thick-
ened fibrous-looking fold or process from the great omentum is
firmly fixed to its lower part, and the whole of this structure
(omentum) was dragged downwards and to the right. The tunica
vaginalis shows the evidences of recent inflammation. The

walls are thickened and lined by soft, shreddy lymph. The
testicle is compressed and atrophied. ( See further, “ Surgical Post-
mortem Records,” vol. I, 1877, pp. 421-22.)

189. An oblique inguinal hernia of the variety known as “ infantile.”
The sac is formed by the unobliterated tubular prolongation of
the peritoneum, which, after having formed the tunica vaginalis,
has remained patent or pervious from immediately above the
testicle to the internal abdominal ring. The contents consist of
omentum only, which seems to have been dragged down into
this position by a slender cord of morbid adhesion to the inner
surface of the sac. No intestine accompanied this omental pro-
trusion. There were no symptoms of strangulation during life.
The sac and its contents were only discovered post mortem.

( Presented by Babu Jadub Chunder Ghose.)

190. A knuckle of the small intestine (ileum), about the size ot a
pigeon’s egg, with a portion of the great omentum adherent to
it, found firmly fixed (strangulated) at the right internal abdom-
inal ring, and thus forming an incomplete inguinal hernia
(bubonocele). On dissecting the inguinal canal on this side a
hernial sac was found, into which this portion of the bowel pro-
truded. This sac extended downwards into the scrotum, and,
as may be seen in the preparation, consists of the unobliterated
funicular portion of the tunica vaginalis (“ infantile ” hernia).
The testicular portion is distinct and separate, invests the right
testis in the usual manner, and does not communicate with the
hernial sac.

The portion of ileum strangulated was situated about four inches above the ileo-ececal
valve. In presented a very dark gangrenous appearance. The whole of
the large intestine was collapsed; the small intestine above the seat of
obstruction was distended with highly offensive, muddy-coloured, fceculcnt
fluid and flatus.

From a native male, aged 30, who died with symptoms of intestinal
obstruction. The groins of the patient were examined on Ins
admission into hospital, but no evidences of hernia could be
detected. (See further, “ Medical Post-mortem Records,” vol. I,
1875, pp. 499-500.)

191. An enormous hernial sac of the right side (inguinal), communicat-
ing with the peritoneum, but separated from the tunica vaginalis.
The latter with the testicle may be seen at the lower part of the

SERIES IX.]

INGUINAL HERNIA.

323

preparation imbedded in the scrotal tissues. The inner surface of
the sac is highly inflamed and vascular, and is coated with lymph
both recent and partially organised. The sac contained, as a
hernia, a portion of the jejunum, the whole of the ileum, the
ccecum, and ascending colon, besides about two pints of sanguineous
serum, and nearly a pound (in weight) of flocculent lymph.

The hernia was of long standing and irreducible. The cause of death
was acute general peritonitis apparently spreading upwards from
the sac. — From a native male, aged 3G. (“ Surgical Post-mortem

Records,” vol. I, 3880, pp. 665-6G.)

192. A specimen illustrative of the so-called “ congenital variety ot
inguinal hernia. A portion ol the small intestine (ileum) is seen
protruded as a hernial tumour into the scrotum, and was strangu-
lated.

The patient, Achow, a Chinese, died during the attempted reduction ol
the hernia by taxis (under chloroform ).

The testicle is seen at the bottom of the sac, the bowel resting, directly
upon it, the cavity of the' tunica vaginalis not having been
obliterated. The tunica, therefore, greatly thickened, constitutes
the sac of the hernia. At its upper part a portion of the small
intestine is seen firmly adherent to the inner surface. To the
right is a diverticulum from the sac, the size of an orange, and
containing a large coil (some eight inches) of the gut. This is
pretty firmly grasped by the constricted neck of the same, but the
strangulation appears to have been chiefly effected byr strong
fibrous bands, which stretched across the interior of the lesser
sac, and which were only discovered when the invaginated coil
of intestine was forcibly drawn out post mortem.

193. A preparation showing the unobliterated or funicular portion of the
tunica vaginalis, forming a hernial sac above the right testicle, and
illustrating the condition of parts in so-called “ congenital” inguinal
hernia. No intestine was contained in the sac. Obtained on post
mortem examination of an American seaman, aged 31, who died
in hospital of cholera.

194. “ A portion of the gangrenous gut of an oblique inguinal hernia,
preserved to demonstrate the extensive disorganization which has
taken place both in the incarcerated intestine and in that which is
in close contiguity to the same.” (Ewart.) ( Presented by Professor
R. O’Shaughnessy.)

195. A portion of the small intestine (ileum), which constituted a
strangulated inguinal hernia, of ten days’ duration, when the
patient (a native male) was brought into hospital. The man
was at once operated upon, but the gut was found quite gangren-
ous and soft, and ruptured on manipulation. It was therefore
excised, and an “ artificial anus ” constructed by stitching the
ends of the ileum, above and below the strangulated portion, to
the margins of the wound. The patient, however, died within
twenty-four hours, from exhaustion and peritonitis. With the
gangrenous intestine about six inches of the ileum above and
below it are preserved. ( Presented by ProfessorS. 13. Partridge.)

324 STRANGULATED HERNIA. [series ix.

196. Strangulated inguinal hernia. A portion of the ileum, with the
coecum, showing gangrene of a small loop of the former, the
result of strangulation in a direct inguinal hernia of the left side.
The bowel was so softened that it gave way on manipulation
after the 6ac had been opened. It was secured to the external
wound by four wire sutures, an “ artificial anus” being thus
formed. The patient, a native male, aged 45, experienced great
relief after the operation, but he gradually sank, and died from
acute general peritonitis. {See further, “ Surgical Post-mortem
Records,” vol. 1, 1878, pp. 451-52.) {Presented by Professor
Gayer.)

197. A preparation showing a ventral hernia, the result of a stab in
the abdomen. The sac is the size of a pigeon’s egg, and is
formed by thickened peritoneum. A portion of omentum pro-
truding into it appears to be twisted upon itself, and partially
strangulated. No history.

198. “ A portion of the anterior abdominal wall (including the peri-
toneum) of a patient who suffered from cirrhosis of the liver
with ascites. He was tapped, and thirty-six pints of fluid drawn
off. Four days afterwards he died. The peritoneum shows
thickening from chronic inflammation, and also from patches of
recent inflammatory effusion.” (Colies.) There is also a hernial
protrusion of this membrane (peritoneum) at the umbilicus.
It is as large as a pigeon’s egg.

199. “ A diaphragmatic hernia. The protruded intestine, about the
size of a man’s fist, is in situ." On the thoracic aspect it is
invested by the peritoneum, shreds of muscular fibre derived
from the diaphragm and the pleura. “ The patient was a
prisoner in the Chupra jail. He had been very severely beaten
with fists and lattees when caught in the act of stealing. In
consequence of this he remained a long time in hospital. There
he frequently complained of pains about the epigastrium, body,
and limbs, but there were no characteristic indications of hernia.
He was cured of these symptoms and discharged. He returned
soon afterwards, suffering from dysentery, from which he died.”
{Presented by Dr. Simpson, of Tirhoot.)

200. A preparation exhibiting the parts involved in inguinal hernia of
the right side, and the results of an operation for the radical
cure of the same. At the time of the operation the sac was
large, and protrusion of the bowel frequently occurred, but was
reducible. A modification of “ Syrne’s operation” was performed.
The patient made a good recovery, and, as the dissection shows,
there is complete obliteration of the sac, while the cord and
testicle remain uninjured and healthy.

Five months afterwards, the man, a French sailor, aged 21, was
re-admitted into hospital with severe injuries to the face and right
hip, the results of a fall from a house when in an intoxicated
condition. He died from pyaemia, and the opportunity was thus
obtained for verifying the results of the operation above referred
to. {Presented by Professor J. Fayrcr.)

SEHIE9 IX.]

RADICAL CURE OF HERNIA.

325

201. A preparation showing the result of an operation for the radical
cure of a right inguinal hernia. The hernia was associated with
elephantiasis of the scrotum, and at the same time that the
latter was removed in the usual manner, the neck of the hernial
sac was occluded by three catgut ligatures, (close to the internal
rins), and the rest of it excised. The ligatures are seen to be
partly encysted but not absorbed, and the canal completely
closed. On both the peritoneal and scrotal aspects there is
a puckered condition of the serous membrane which formed
the neck of the sac, and a little inflammatory exudation over
the catgut, but there was no peritonitis.

About a week after the operation, the perineal wound sloughed, and
this condition extending to the cords and testicles, while burrow-
ing abscesses formed in the loose cellular tissue of the buttocks
and inner sides of the thighs, — the patient, a Mahomedan (male),
aged 30, died from exhaustion and septicaemia. [See further,
“Surgical Post-mortem Records,” vol. I, 1881, pp. 771-72.)
( Presented hi/ Professor K. McLeod.)

202. A portion of the jejunum showing an abrupt and tight stricture,
which was situated at a distance of about twenty-eight inches
from the pylorus. The constriction has apparently been pro-
duced by the healing or cicatrisation of an old ulcer. Its
chronicity is evidenced by the marked hypertrophy of the mus-
cular coat, with dilatation of the channel of the bowel above
the stricture. These conditions extended upwards for more than
twenty inches. No other constriction or ulceration was found
in any part of the intestine, and no history could be obtained
of the present lesion, as the patient, a native male, aged 3G,
was admitted into hospital in a moribund condition, and died,
within twenty-four hours, from acute pericarditis and pneumonia.

203. A preparation showing ragged ulceration of the rectum, per-
foration of the bowel, and the establishment of a communication
between it and the vagina anteriorly, and the recto- uterine
cul-de-sac superiorly. The ulceration is accompanied by enormous
thickening of the muscular coat of the intestine, so much so as
to have produced very considerable constriction of its channel
during life. The disease was suspected to be cancerous. There
is, however, no evidence of any malignant growth in the walls
of the rectum or its neighbourhood. Under the microscope, no
cancerous or other morbid stricture is to be found, and, as there
are evidences of dysenteric changes throughout the portion of
gut preserved,— viz., numerous shallow, chronic ulcers, &c., — it is
presumable that the whole disease is dysenteric only in character.
— “ From a native female ” (age not recorded).

204. Fibroid stricture of the rectum, about four inches above the
anus. The thickening involves the submucous, muscular, and
peritoneal coats for a space about three inches in length in this
portion of the gut. The mucous surface shows unhealthy
ulceration extending throughout the constriction, and down-
wards to the very verge of the- anus. One complete fistula and
two or three blind internal fistukc are seen burrowing beneath

326

ARTIFICIAL ANUS.

[series IX.

the mucous membrane, two inches above the anal aperture, while
the latter presents a fissured and tuberculated appearance, due to
a thickened, hypertrophied and redundant condition of the skin
and mucous membrane surrounding it.

Examined microscopically, there is no trace of cancerous structure in the thickened
tissue forming the stricture The submucous glands are found atrophied,
the muscular tissue hypertrophied, and all these diffusely and thickly
infiltrated with a small-celled or nuclear growth, itself undergoing, in parts,
fibrillation. These conditions, with the unhealthy form of ulceration at the
seat of stricture, may possibly indicate syphilitic contamination (of which,
however, there was no history obtainable), but no other specific disease.

From a native male, aged 30, who died from erysipelas and peritonitis
following- the division of one of the anal fistulse.

205. “ Portion of descending colon and abdominal wall, showing
artificial anus, formed by Amussat’s operation, in a case of
obstinate constipation. The patient, a Hindu (male), survived the
operation thirty hours. There are no traces of inflammation
or union having begun.” (Colies.) ( Presented by Professor
Chuckerbutty.)

206. A knuckle of the small intestine (jejunum), which constituted
a strangulated hernia (left inguinal), and the lower portion of
which sloughed spontaneously, leaving the “ artificial anus ” seen
in the preparation. This condition of parts was found on
opening the sac of the hernia at the time of operation. The
patient, a native male, aged 30, died from peritonitis. ( See
further, “ Surgical Post-mortem Records,” vol. 1, 1880, pp. 729-30.)

207. “ An old external pile. The hairs indicate where the skin begins,
and the thickened and altered mucous membrane ends. It had
given a good deal of trouble, and caused bleeding from the
interior of the rectum.” (Ewart.)

208. “ Four external piles (haemorrhoids), excised from around the
anus of an American, aged 23. ’ f Presented by Dr. J. I ayrer.)

209. A portion of the lower end of the rectum, showing (1) a fringe
of external haemorrhoids round the margin of the anus, (2) an
irregularly eroded and roughened condition of the mucous
membrane for two inches above this, indicating the situation
where ligatures were applied for the removal of. internal piles ;
and (3)*a deep, true ulcer, exposing the muscular coat, and
about as large as a rupee, situated about two inches still
higher.

The middle “ fold of Houston,” — a thick and prominent reduplication of
the mucous membrane, — two and a half inches above the anal
aperture, is well marked.— From a European male, aged 25, who
died from perforating ulcer of the ileum, anti geneial peritonitis,
both apparently unconnected with the operation upon the
rectum.

210. “ Prolapsus of the rectum. The measurement from the integu-
ment to the extremity of the prolapsed gut is about four inches,
and it is about three inches in breadth There are several large

SEBIES IX.]

POLYPI OF THE INTESTINE.

327

ulcers on the extended mucous membrane.” (Ewart.) ( Presented
by Professor Allan Webb.”)

'211. A large prolapsus ani with the thickened, integumental-like,
everted mucous membrane, — removed by combined ligature and
excision. From a native male patient. The mass is as large as
one’s fist, and illustrates well both the anatomical and patho-
logical character of this disease. The man died on the twenty-
sixth day after the operation from tetanus. There was no
peritonitis. ( Presented by Professor S. 13. Partridge.)

212. Prolapsus of the rectum and sigmoid flexure, forming a tumour
the size of the foetal head. The external surface is thickened,
leathery, and ulcerated from long-continued exposure. Peri-
tonitis was set up between the opposed serous surfaces of the
everted bowel, and, becoming general, terminated fatally. — From
a native male, aged 36. (See further, “ Surgical Post-mortem
Records,” vol. 1,1875, p. 188.)

213. “ Portions of jejunum of Ram Persad, who died of cholera,
showing several small fatty tumours on the inner surface of the
bowel. One is pendulous, ovoid, and larger than a grape.”
(Colies.)

The structure under the microscope is purely fatty. Two of the growths are sessile,
one polypoid. They all appear to have developed from the submucous
connective tissue, and receive an investment from the common mucous
membrane, which forms also a distinct capsule round the polypus. —
J. F. P. McC.

214. “ Portion of the colon from the mucous membrane of which a
small grape-like tumour protrudes. It consists of fat deposited
beneath the mucous membrane.”

1 “ The patient came in moribund from dysentery. There was thinning
and slight inflammation of the colon, but no ulceration.” (Colies.)

1 The little growth described is a polypoid lipoma.

; 215. “ A very large rectal polypus from a native male (Bukshoo),

aged 63 years, removed by ligature.” The tumour is ovoid in
shape, about the size of a turkey’s egg. It is smooth externally,
soft and succulent on section. Consists (under the micro-
scope) of broad-meshed fibro-elastic tissue, holding in its interstices
a large quantity of yellow fat (fibro-lipoma).

216. About three feet of the ileum from a case of “ Hodgkin’s Disease”
(lymphadenoma),— a native female, aged 25.

The peritoneal surface of the bowel is seen thickly covered with opaque
milky-white granulations and flattened nodules, varying in size
from a barley-grain to a large pea. These are soft on section,
and consist of nucleated cells, closely resembling white blood-
corpuscles, imbedded in a delicate, small-meshed reticulum of
connective tissue. Others are partially or completely cheesy.

The whole of the abdominal peritoneum was infiltrated with granules,
nodules, or patches of similar character ; the spleen also ; and, in
the thorax, the lungs, pleurse, mediastinal and bronchial glands.
( See further, “ Medical Post-mortem Records,” vol. I 1875
pp. 517-18.)

328

MALFORMATIONS OF THE INTESTINE, [series ix.

217. An hypertrophied “ epiploon,” the size of a small orange, found
attached to the transverse colon of a native female, aged 50,
who died from dysentery.

218. “ Part of the lower end of the small intestine with a diverticu-
lum three inches long, into which is inserted a red glass rod.
The communication between the pouch and the intestinal canal
is sufficiently capacious to admit the little finger.” (Ewart.)

219. “ A piece of the ileum with a pouch or diverticulum from it,
about three inches long, and an inch in diameter.” (Ewart.)

220. A finger-glove-like diverticulum from the ileum. It was
situated about four feet above the ileo-ccecal valve. To its
fundus is attached a cord-like or vermiform appendix, about four
inches in length, the diverticulum itself measuring three inches
in length by one in breadth.— From a native male patient,
aged 35, who died from acute miliary tuberculosis,

221. A double conjoined diverticulum, found about four feet above the
ileo-ccecal valve, in the small intestine of an East Indian (male)
patient, who died from uraemic apoplexy. The smaller pouch is
about an inch in length and half an inch wide ; the larger,
three inches long and one broad. They are sepai’ated by a
distinct prominent fold of mucous membrane, but open into the
ileum by a common rounded orifice.

222. A- small diverticulum, situated at the junction of the duodenum
and jejunum. It is about an inch in length and half an inch
in breadth, and opens into the intestine by a wide, rounded orifice,
the size of an eight-anna (shilling) piece. — From a native
female, aged 31, who died of cholera.

223. Specimen showing a diverticulum about two inches wide, and
and an inch and a half in length, situated at the junction of the
duodenum with the jejunum. It communicates with the bowel
by a rounded orifice, the size of a rupee.

Found on 'post mortem examination of the body of a native male,
acred 54, who died from hepatic abscess, &o.

224 A small diverticulum found at about the middle of the ileum.
It is nearly two inches in length, and wide enough to admit the
thumb. Communicates with the bowel by a rounded opening,
the size of a four-anna piece, and terminates very curiously _ in
three separate and distinct coecal expansions, thereby presenting
a kind of trifoliated appearance. — From a native male, aged 25,
who died from cholera.

225 An abnormally long appendix vermiformis of the coecum, from
a native female, aged 30, who died of cholera. The tube measures
nine inches.

226 “ Bladder and rectum of a child with imperforate anus. The
bladder is laid open posteriorly, showing the position of the
urethral orifice, through which a red glass rod has been passed.
Two dark glass rods arc inserted into the ureters, which occupy
the usual ‘’place. The rectum terminates in a small cul-de-sac,
about two inches long, behind the neck of the bladder. It
has been opened here on its anterior aspect and filled with

IMPERFORATE ANUS.

B29

ISEBIES IX.]

cotton. The remainder of the gut is much smaller and natural
in dimensions.

An operation was performed for the relief of this abnormal state of things,
by attempting to tap the blind gut with a trochar and canula ;
the instrument penetrated the prostate gland, and reached to
a point about the eighth of an inch from the termination of
the rectum. The wound inflicted by the trochar is seen to be
on the left side of the mesial line, and is now held apart by
short black glass rods.

The urethra opened behind the glans penis, and meconium was passed
by this channel during life.” (Ewart.) “No communication
could be traced between the bowel and the bladder, though both
organs had been blown independently of each other, no air
passing from one to the other.” ( Presented by Professor T. E.
Charles.)

227. “ A specimen of imperforate anus. The rectum arrested in its
progress towards complete development. The bladder and pelvic
bones (cartilaginous) are in situ. The pubes have been removed
to give a more perfect inspection of the exact condition of the
parts. The rectum has been developed to within an inch of the
usual point of exit, which is indicated by the introduction of
a glass rod. Four inches above the blind end the gut is
enormously dilated.” (Ewart.) The anal depression in the
skin is well marked, although found imperforate as above
described.

228. “A preparation demonstrating the condition of the rectum in
imperforate anus. The arrest of development has taken place
within a quarter of an inch of the usual site of the anal orifice.
An artificial opening leads immediately into the dilated gut,
a longitudinal section of which has been made. The dilata-
tion is chiefly confined to the rectum. The portion of the
sigmoid preserved indicates an insignificant increase in its
capacity.” (Ewart.)

11229 “ Abdominal and thoracic viscera of a child born in the Medical

College Hospital with imperforate anus and malformed genitals.
It took the breast but never made water (although after death
urine could be made to flow freely by pressure on the bladder).
The penis is small, the scrotum consisted of two folds of skin
resembling labia, separated by a fissure a quarter of an inch wide,
at the bottom of which the ordinary skin of the perineum was
visible. These labial folds contained no testes ; they were
continuous above the penis, forming a “ fourchette,” with a free
crescentic margin. No dimple or other trace of anus.

Viscera. Thoracic, healthy; heart normal; lungs well inflated; thymus gland
well developed. Stomach and duodenum both greatly distended with air,
so that the two at first sight resembled a stomach with “ hour-glass” con-
traction. Small and large intestines very much contracted, except the
sigmoid flexure, which is enormously distended, and contained about an
ounce of meconium. The sigmoid flexure ends in a constricted portion
about one-third of an inch long and one-sixth of an inch wide, which
becomes continuous with the superior and posterior part of the bladder.
The latter reaches to the umbilicus, and contained about half an ounce of

330 PREPARATIONS FROM THE LOWER ANIMALS, [series ix

urine. Air cannot be forced from the bladder into the sigmoid flexure,
nor meconium from the latter into the former. A large convoluted
ureter reaches from the posterior inferior part of the bladder on the left
side to the left kidney. Prom the lower angle of the latter a hand of
glandular substance passes in front of the aorta, and terminates in a mass
not much larger than a pea, partly glandular, partly vesicular, which is the
only representative of the right kidney. Supra-renal capsules equal. Other
viscera healthy. The aorta divides below the kidneys into a small left
branch (which must have given off the iliacs), and a large right one, which
looks like its continued trunk, and becomes the solitary umbilical artery.

The infant appeared of full age. No testes or ovaries in abdomen. No
sign of uterus.” (Colles.) ( Presented by Professor T. E. Charles.)

230. “ Abdominal viscera and part of the pelvis of a child operated
on four days after birth for imperforate anus. The ileum was
opened in the right groin near the ccecum. The child lived for
six days after the operation.” (Colies.) ( Presented by Professor
D. B. Smith.)

231. “ A portion of the ileum of a tiger, with two perforations half an
inch from each other, and bones and teeth. The edges of the
apertures are smooth and lined by a layer of lymph.” (Ewart.)

“The subject of the case was a full-grown male, which died in the Government
Park at Madras. The animal, for some days before his death, had refused
his food, and appeared very ill ; he was hot and feverish, and his belly
tense and painful. In this state he remained for several days, never
attempting to change his position, passing no foeces, and scarcely any urine.
The body was examined twelve hours after death. The abdomen contained
about five pints of very offensive thin yellow fluid. The abdominal and
visceral peritoneum were highly inflamed. The ileum for about three
inches of it3 lower third was swollen and converted into a hard tumour,
having six perforations through its coats, the widest (more than three lines
in diameter) was closed by a portion of bone, and sharp-pointed spicula
were seen projecting through the other foramina. Within the swollen part
of the intestine there were many loose pieces of bone, and a round ball formed
of several angular bits of bone, agglutinated and bound together by a kind
of network of hair and wool. This ball adhered slightly to the intestines
by means of adventitious tissue, which was highly injected.” (Note by
Dr. Benza.) ( Presented by Dr. Benza, of Madras.)

232. “ Intussusception of the small intestine of a horse.” (Ewart.)

233. Intussusception of the coecum and a portion of the ileum into
the ascending colon of a bitch. ( Presented by Mr. Fraser,
Imperial Museum, Calcutta.)

234. A portion of the ileum, just beyond the ileo-coelic valve, about
twenty-eight inches in length, strangulated by perforation of the
great omentum. From a horse who died with all the symptoms
of internal obstruction of the bowels. ( Presented by R. S. Hart,
Esq., m.r.c.v.s., Calcutta.)

235* A preparation showing a long-standing hernia (umbilical) of a
portion of the ileum of a horse, with fatal perforation of the
same from sloughing of the superjacent skin of the abdomen.
( Presented by R. S. Hart, Esq., m.r.c.v.s., Calcutta.)

236. Diphtheritic or crupous inflammation of the small intestine of a
horse. A small portion of the ileum (which was throughout
affected) is preserved. The mucous surface is covered by a well-

DISEASES OF THE MESENTERY.

331

• SEBIES

IX.]

defined false membrane, about two lines in thickness, which
can readily be peeled off with the forceps. The structure, as
seen under the microscope, is very simple, consisting chiefly of
round, granular cells, closely packed together ; some exhibiting
fatty changes, others shrivelled and distorted ; these are imbedded
in a soft, fibrinous, slightly filamentous basis-substance. A lew
shred and altered epithelial cells are also visible. ( Presented by
R. S. Hart, Esq., m.r.c.v.s., Calcutta.)

237 A portion of the large intestine of a female Uran-utan ( Simia
satyrus), which died in the Zoological Gardens, Calcutta, showing
extensive pitted, dysenteric ulceration ot the mucous membrane.

( Presented by Dr. J. Anderson, Calcutta.)

238. “ A specimen displaying a perforating wound of the mesentery.
The edges of the wound are more or less ragged from suspended
shreds of lymph. The neighbouring intestine is penetrated.
The injury was inflicted during an affray which took place at a
gambling party. The man died from general peritonitis, brought
on by extravasation of foeces, and from internal haemorrhage.
The two lumbrici present were taken from the intestine.
(Ewart.) (Presented by Dr. W. H. 13. Ross, of Jessore.)

239. A portion of the great omentum showing great thickening and
abnormal opacity, the results ot chronic inflammation (peri-
tonitis).

240. Enlargement, tumefaction, and great vascularity of the mesen-
teric giandsin a case of typhoid or enteric fever, a native female,
aged 22 (see prep. No. 104). The affected glands vary in size
from a pea to a chesnut, and on section are very soft and pulpy.

241. Swollen and highly vascular mesenteric glands from a case of
typhoid fever. The subject was a native male, aged 21. The
solitary glands and patches of Peyer in the last eight inches of
the ileum were infarcted and ulcerated ; one or two of the latter
had partially sloughed. (See prep. No. 93.)

242. The mesentery from a case of typhoid or enteric fever, a Hindu
boy, aged eight years. The glands are much enlarged, soft,
and swollen ; and, in the recent state, were very hypersemic.
One or two have attained the size of a pigeon’s egg. (See
further, prep. No. 95.)

243. A similar specimen from an Armenian boy, aged 7 years.
( See in connection prep. No. 98, and “ Medical Post-mortem
Records,” vol, I. 1875, pp. 713-14.)

244. Enlarged mesenteric glands from an East Indian boy, aged 7
years, who died from cholera. The largest gland is about the
size of an almond. On section all present a pretty firm, opaque,
creamy-white colour at the periphery, and are pinkish and
hypersemic towards the centre (in the fresh state).

Although these glands are always larger during early life than in the adult, yet it
has been repeatedly observed that in cholera the hypertrophy is at all ages
abnormal — i. e„ pathological. Probably this condition corresponds to the
similar alteration which takes place in the glandular structures of the
entire alimentary canal, from the month downwards. (See also preps
Nos. 4 and 71 from the same case.)

332

TABES MESENTEBICA.

[semes IX.

245. Tabes mesenteries A preparation exhibiting enormous strumous
enlargement of the mesenteric glands. They vary in size from
a pea to a sparrow’s egg. The majority are more or less uni-
tormfy affected ; one or two show incipient softening and con-
sequent disintegration. No history.

246. A preparation described as “ scirrlius of the mesenteric glands”

(Ewart), but found, on microscopic examination, to exhibit no
cancerous structure. In consists of a series of greatly enlarged
and cheesy mesenteric and lumbar glands, closely and firmly
matted together by much dense fibrous or connective tissue
A tew of the glands have undergone softening, and even lique-
faction. 1

247. Tabes one sent eric a. A portion of a large mass found in the
abdomen, and consisting of greatly enlarged strumous (cheesy)
mesenteric glands. Some of the individual glands are the size
of a potato. At the autopsy, the whole of the small intestine
was found in close apposition to these glands, the mesentery
being throughout thickened and fore-shortened. The lumbar
glands were similarly affected, and the kidneys with their ureters
the choledic ducts, pancreas, &c., all involved in the diseased
process, so that these parts were abnormally rigid and insepar-
able, and thus almost the whole of the contents of the abdomen
were capable of being removed en masse, and formed a gigantic
tumour, the size of a water-melon.

The tubercular or strumous growth in these glands appears to have
been a primary pathological change, for no trace of tubercular
ulceration was discovered in any part of the intestinal tract.

248. Miliary tuberculosis of the mesentery, with caseous infarction
of the mesenteric glands. No history. (Presented by Dr. J.
Fawcus, Calcutta.)

249. The mesentery of a native female, who died from phthisis and
tubercular ulceration of the bowel, showing, very typically,
the enlarged condition of the lymph-glands from commencing
tubercular infiltration.

250. The mesentery and a portion of the pancreas from a native
male,. (Hindu), aged 42, who died from tubercular phthisis and
enteritis. “The mass weighed 21b. 5ozs.” The pancreas is
apparently healthy. The mesentery and its glands are infiltrated
with tubercle. The latter are greatly enlarged, and, on section,
firm and cheesy.

251. Cheesy degeneration of the mesenteric glands, which are
enormously enlarged, hard, firm, yellowish- white on section.
Some have attained the size of a hen’s egg.— From a native
male, (Mahomedan), aged 55, who died from phthisis and
tubercular ulceration of the small intestine.

252. Mesenteric glands enormously enlarged, firm, cheesy, and tuber-
cular. From the same patient as prep. No. 80,- an East Indian
male, aged 28, who died from phthisis and tubercular enteritis.

253. Mesenteric glands enlarged, and in various stages of tubercular
caseation.

SEBIES IX.]

LYMPHADENOMA.

333

The majority of the glands are as large as a nutmeg, are yellowish and
firm. Several are not uniformly affected, but show remarkably
well the peripheral infiltration of their proper structure (enchyma),
the change being observed in individual follicles thus situated.
The whole of the mucous membrane of the small intestine
was occupied by large tubercular ulcerations. — From a native
male, aged 10, who died from phthisis and colliquative
diarrhoea.

I 254. Tabes Mesenterica. The mesentery of a native male patient,
aged 20, who died in hospital from acute, general (miliary)
tuberculosis. The mesenteric glands are enormously enlarged, and
by coalescence form rounded tumours varying in size from a
walnut to a hen’s egg, or even larger. They are seen, on section,
to be soft and cheesy.

255. A portion of the great omentum thickly infiltrated with minute
tubercular growths, in the form of innumerable opalescent
granules, about the size of sago-grains. These are especially
thickly distributed along the course of the small mesenteric
vessels.

On microscopic examination they present all the histological characters
of true tubercle (miliary granulations).

Both parietal and visceral layers of the peritoneum were similarly and
diffusely affected. The patient, a native male, aged about 32,
died alter amputation at the ankle-joint for strumous disease
(caries) of the tarsus. ( See further, “ Surgical Post-mortem

I Records,” vol. I, 1875, pp. 229-30.)

5256. About two feet of the ileum, and a portion of the descending
colon, showing small nodular and granular infiltration of the
peritoneal coat and sub-peritoneal cellular tissue with tubercle.
1 rom the same case as the preceding preparation (No. 255.)

5257. 1 he great omentum and mesenteric glands exhibiting diffuse tuber-
cular infiltration. In the former it takes the shape of opaque-
white growths, varying in size from a mustard-seed to a pea, and
producing a peculiar u shotty” condition and appearance of this
membrane Some of these growths are hard and calcified. — From
a native male, aged 35, who died from pulmonary phthisis.
(See further, “ Medical Post-mortem Records,” vol. II, 1877
pp. 347-48.)

258. A portion of the mesentery greatly thickened from the presence
of multiple nodular growths, varying in size from a hazelnut to a
swan-shot. These consist of lymphoid or adenoid tissue, and
formed a general infiltration of all the abdominal organs, the
diaphragm, Ac., (“ Hodgkin’s Disease” or lymphadenoma). — From
a native female, aged 40, who died in hospital. She was
extremely anaemic, and had long suffered from a profuse
leueorrhoeal discharge.

E59. The mesentery and mesenteric glands from a case of Hodgkin’s
disease (lymphadenoma), -a native female, aged 25, who was
bi ought into the hospital in a moribund condition. The "lands
and mesentery generally are seen infiltrated by an opaque milk-
white, somewhat waxy-looking growth, in the form of small

334

EUPTUEE OF THE LIVER.

[series IX.

granules nodules and interstitial thickenings. The structure
(microscopic) of these is purely lymphomatous. Some of the
glands are partially cheesy. The spleen, diaphragm, peritoneum,
«fec., were all similarly effected.

260. Portions of the small and large intestine, and the mesenteric
glands from a case of genuine leprosy {P. Oroecorum), — a
European male, aged 22.

The external aspect or peritoneal surface of the bowel is covered with
opaque-white tubercular-looking granulations and excrescences.

Examined microscopically, these exhibit a lymphoid structure, but. the. cell-elements
are not so uniform nor so well defined as in ordinary adenoid tissue. Among
them also, here and there, are found larger, irregular-outlined, more or less
angular or pyriform cells, which perhaps are truly “leprous; and also, a
considerable amount of blood -pigment (heematoidin) in amorphous granules,
and well marked rhombic prisms.

The mesenteric glands are all enlarged, but apparently only
from simple over-growth, — i.e., normal hyperplasia: show

no caseous transformation. The mesenteric vessels (the
arteries in particular) appear to have abnormally thickened and
dilated walls. ( See further, “Medical Post-mortem Records,”
vol. I, 1875, pp. 765-66.)

261. Calcification with slight enlargement of the mesenteric glands.
Sections of five of these are presented to view. “ No tubercles
existed in the lungs,” and the mucous membrane of the intestine
appears to be quite healthy. {Presented by Dr. T. Oxley, of

Singapore.) _ .

262. Mesenteric glands showing melanotic, cancerous infiltration.
From an East Indian (male), aged 44. The brain, lungs, liver,
bones, &c., were all similarly affected, the case being one of
diffuse melanosis. The structure is that of “ enkephaloid.
{See further, “Medical Post-mortem Records,” vol. T, 1873, p. 16.)

263 Extensive laceration and purification of the upper third of the
right lobe of the liver, especially of its superior margin, just
below the diaphragm. Taken from a native male, who was lun
over in the street by a buggy, which fractured all the ribs on
the right side of the chest, and at the same time caused the
above injury.

The rwht kidney was also lacerated, the right lung contused, and the right pleural
^ cavity filled svith blood. The abdominal cavity contained about two pints
of extravasated blood.

264 Extensive rupture of the liver, the result of a blow. The left
lube is almost completely separated from the right, the rupture
extending along the suspensory ligament, through the whole
thickness1 of the organ, except for about one inch at the super-
ior border. At this upper border there is a second laceration,
about two inches in length, involving also almost the whole
thickness of the liver. At about the centre of the anterior
(convex) surface of the right lobe is seen the remains of a cyst,
with thick, leathery, well-defined walls of organised, fibrous or
connective tissue. This, together with the adjacent livei su

SERIES IS.]

DEFORMITY OF TIIE LIVER.

335

stance, lias evidently been incised (post-mortem) in a transverse
direction. On the under surface of the same lobe is another
smaller cyst, the size of a hen’s egg. It is filled with thick,
creamy, yellowish-white fluid, which, examined microscopically,
consists of “ granule-cells” and “ masses ” of varying size ; also a few
faint-outlined, small, round cells, probably withered pus-corpuscles.
Probably both cysts represent the remains of old abscesses.
The capsule of the liver is everywhere a good deal thickened
The organ itself is somewhat contracted and ineipiently
cirrhotic. — From a native, aged about 40. “ lie is said to have

received a severe blow with the fist on his back, and fell forwards
on his abdomen to the ground.”

265. Deformity of the outline of the liver, probably the result of
long-continued compression. From a Portuguese lady, aged 45,
who died of phthisis.

The constriction or indentation extends transversely across the convex
surface of the right lobe, the outer border of which presents a
shallow notch. The right kidney was also distinctly flattened
along its outer border. The deformity is probably the result of
ti^ht-lacinsr or tisrht-belting of the body.

266. A section from the right lobe of the liver showing a wedge-

shaped, port-wine-coloured, hajmorrhagic infarction. — From a
native male, aged 50, who died from acute suppurative
nephritis, after the operation of lithotomy. ( See further,

“Surgical Post mortem Records,” vol. I, 1873, p. 24.)

267. A portion of the right lobe of the liver exhibiting a small
circumscribed blood extravasation at the surface, just beneath the
capsule. It is situated on the anterior or upper surface, about
an inch from the outer margin and lower border of the organ.
— From a native male, aged 35, who died from morbus cordis
(mitral stenosis.)

268. Highly contracted and cirrhotic liver. “ The whole organ is
contracted, till it does not exceed in size two closed hands. It
has been minutely injected with vermilion, and the solidification
which it has undergone from disease is thus rendered more
apparent. Some of the lobules are pushed out by the contrac-
tion of the intermediate tissue of Glisson’s capsule, which has
undergone adhesive inflammation. This gives the whole organ a
tubercular aspect, although there is in reality not a single
tubercle in it. The vascularity of the gall-bladder is well
shown.” (Allan Webb.) (Pat'holoqia Indica, No. 340, p. 254.)

269. Well marked cirrhosis of the liver. The organ is atrophied.
Its surfaces are throughout tuberculated, nodulated, and rough.
The capsule is thickened and puckered. The gall-bladder is
greatly distended, and its walls thinned. The cystic duct is so
small and contracted that a probe can only with difficulty be
passed through it, (indicated by a fine glass rod). No history
except a note to the effect that “ the patient died from ascites.”
(Presented by Professor F. J. Mouat.)

336

CIRRHOSIS OF THE LIVER.

[series IX.

270. A very characteristically contracted and cirrhotic liver, with great
nodulation and tuberculisation of its surfaces. — From a European
seaman, John Henry, aged 70, “who had suffered from ascites
for a long time.” ( Presented by Professor Chuckerbutty.)

271. Extremely atrophied and cirrhotic liver,— a very typical example.

( Presented by Professor D. B. Smith.)

272. Well marked “ hob-nail” or cirrhotic liver, from a woman aged
50. History imperfect, but none of intemperance.

273. The liver of a native male (Hindu), aged GO, who died from
dysentery. The capsule is opaque, thickened, and puckered
everywhere. The surface is nodulated, and the whole organ con-
siderably deformed and atrophied. It is firm and tough on sec-
tion, and exhibits much fibroid thickening of the interlobular
connective tissue, with all the other characters of true cirrhosis.

274. Extreme cirrhotic atrophy of the liver, from a native male (Hindu),
ao-ed 23. On his admission into hospital there was ascites with
great anasarca of the lower extremities. The liver is small,
much contracted, and the right and left lobes imperfectly
separated. It is firm in consistency. The surfaces are marked
by eminences and hard nodules, varying in size from a pigeon’s
egg to a pea. On section, the hepatic parenchyma presents a
coarsely granular appearance, these granules consisting of isolated
groups' of three, four, or more conjoined and compressed lobules,
surrounded by a varying thickness of firm fibrous tissue. The
atrophy especially affects the left lobe, which is reduced to an
extremely small size.

275. Liver highly cirrhosed. Weight 22£ ounces. From a native
lad, aged 16, who died in hospital. This preparation is preserved
to illustrate the form or variety of cirrhosis which, apparently,
often develops in this country under the influence of malarial
agency. This hoy s history pointed to lepeated fevei, but
there was no indication whatever of spirit-drinking, &c.

276. A very markedly cirrhotic or “ hob-nail ” liver, with also con-
siderable dark pigmentation of the superficial parenchyma.— From
a native male, aged 50, who died in hospital. There was a history
of spirit-drinking. (“ Medical Post-mortem Records,” vol.
II, 1878, pp. 747-48.)

277 A very small cirrhotic liver, with almost complete atrophy of
the left lobe. The entire organ weighs only 23^ ounces. — From
a Hindu, aged 45, who died in hospital.

Qf7g r\ preparation described in the old catalogue as the circatnx of
an old abscess of the liver. ” (Ewart). It is, however, a well
marked "ummy or syphilitic growth. On the upper surface of a
portion of the right hepatic lobe a greatly depressed cicatricial-
like thickening of the capsule is observed, with the remains of
a few organised bands or tags of lymph, by which probably this
part was united to the diaphragm. On section, the thickening
of the capsule extends downwards into the parenchyma, and is
associated with a small, ill-defined growth, the size of a sparrow’s
egg, here situated.

SEflIES IX.]

SYPHILITIC HEPATITIS.

837

Sections under the microscope exhibit (1) much interlobular fibrous growth, the
connective tissue being hyperplastic, and infiltrated with round embryonic
cells and nuclei; (2) atrophy of hepatic lobules by compression, with isolation
of hepatic cells in alveolar-like spaces, the cells, themselves, not much
altered, except that some are more oily and granular than normal; (3)
much thickening of the coats of the blood-vessels, with nuclear proliferation
around them. All these characters may be justly referred, even at so long
a date as this, to true syphilitic infection and new growth. ( Presented by
Dr. F, J. Mouat.)

279. A small portion of the liver of “ a patient who died from syphilitic
laryngitis, &c.” There is irregular thickening and cicatricial
puckering of the capsule, and, on section, one large and several
smaller nodes, surrounded and intersected by bands or strands of
connective tissue continuous with the capsule of the organ.

Under the microscope, the central portion of the nodules consists of granular
amorphous, fatty debris ; towards their periphery, atrophied hepatic cells
are found, and others in a state of proliferation, — their nuclei dividing, and
the protoplasm 0f the cells swollen and highly granular. These conditions,
indicate syphil^^ (gummatous) growth. (See also prep. No 26, Series VII.)

280. Syphilitic hepatitis. Liver showing much deformity, especially
of the right lobe, from cicatricial-like puckenngs and localised
thickenings of the capsule, with corresponding deep fissuiing
and indentation of the surface of the organ. These are best
marked on the anterior convex surface of the organ. A fibroid
growth extends downwards from these spots into the hepatic
parenchyma for a variable distance (half an inch to an inch) , and
the hepatic tissue around each such growth is atrophied and
displaced. The lesions are undoubtedly syphilitic.

Taken from a Chinaman, admitted into hospital in a very debilitated
and exhausted condition, with specific (syphilitic) sloughing of the
whole of the soft palate.

281. Hepatitis syphilitica. Liver small, very'' much' deformed and
irregularly lobulated. The capsule is thin and" transparent in
some places, while in others it is remarkably dense, and fibrous,
and forms cicatricial-like depressions, which, when incised, reveal
the presence of gummatous growths, and much thickening of
the interlobular connective tissue in their vicinity. The growths
consist of rounded nodules with caseous centres. The largest
of these is situated at about the centre of the suspensory
ligament. It is the size of a pigeon’s egg, and evidently
formed by the coalescence of three or four smaller nodules. Other
solitary and smaller, but structurally homologous growths may
be observed distributed irregularly near the surface, and chiefly
in the right lobe. The hepatic substance generally is soft and
greasy; the lobular structure indistinct. No cirrhosis and no
amyloid degeneration. — From a native female, aged 35, who
died from scorbutic dysentery. ( See further, “ Medical Post-
mortem Records,” vol. II, 1876, pp. 257-58.)

282. A small contracted liver. In the right lobe, at its inferior
margin, surrounding and involving the gall-bladder, and obstruct-
ing the cystic and choledic ducts (at the transverse fissure),
is a firm, fibroid, gummatous-looking growth, about the size of

338

SYPHILITIC HEPATITIS.

[series IX.

an ordinary potato. Closely examined, it appears to consist of a
series of coherent nodules, the structure of which has a more
or less concentric arrangement. In parts it is seen infiltrated
with small, semi-transparent, gelatinous-looking granules. There
is no other tumour in the liver, which is incipiently cirrhotic.
The gall-bladder has been almost obliterated, — a narrow channel
with thickened walls, and containing a few drops of limpid, clear,
slightly -yellowish fluid alone represents it, and the biliary canals
throughout the liver are dilated, and filled with similar fluid.

On microscopic examination the naked-eye appearances of the growth are confirmed.
It consists of a series of nodules, united by nucleated fibrous tissue and the
remains of hepatic cells. The nodules are also fibrous in structure, but
show, towards their centres, a hyaline condition or transformation — pro-
bably colloid infiltration — of the degenerate portions of each gumma. The
hepatic cells in the neighbourhood of these growths are also large, swollen,
and colloid-looking (not amyloid). The tumour is therefore, in all pro-
bability, a true localised “syphiloma,” complicating or co-existing with
incipient cirrhosis of the entire liver.

From a native female, aged 53, who died from dysentery with obstruc-
tive jaundice. ( See further, “ Medical Post-mortem Records,”
vol. II, 1877, pp. 393-94J

283. Sections from an hypertrophied liver, showing several circum-
scribed, fibroid-looking nodular growths or gummata. The
whole organ was much enlarged and heavy,— weighed 6ft 2ozs.
The general parenchyma is fatty and also amyloid. The patient,
a native male, aged 40, died in hospital from perinephritic
abscess, &c.

Sections made through several of these growths, and examined microscopically,
show that they are separated indistinctly or incompletely from the surround-
ing hepatic tissue by a zone of proliferating round cells, with a delicate
fibrillated intercellular substance, and this is also the structure of the
• peripheral portions of each nodule. As the centre is approached, both
fibrous and cellular elements are obscured by a gradually increasing fatty
metamorphosis, and in parts by a more glistening and hyaline change (not
coloured by iodine) — probably mucoid ; until at last, at the very centre,
nothing but a granular and molecular fatty debris can be recognised.
The hepatic cells are slightly enlarged, fatty, and coarsely granular, besides
which, a very large number present a transparent, waxy-looking condition
from amyloid infiltration, and, on iodine solution being applied, the greater
portion of each lobule gives the characteristic reaction.

The kidneys were contracted, and also amyloid. ( See further, “ Surgical
Post-mortem Records,” vol. I, 1877, pp. 381-S2.)

284. Syphilitic hepatitis. A section from the right lobe of the liver.
On its anterior surface, near the upper margin, there is a small
rounded, fibrous-looking growth, and, at its lower margin, a
partially cheesy mass, consisting, apparently, of three or four
similar nodules which have coalesced.

Examined microscopically, these growths consist of well-formed though delicate
and nucleated connective tissue, either taking the shape of broad bands,
proceeding from the capsule, for a variable distance, into the liver paren-
chyma, or of concentric nodules of the same material, including in their
areas portions of hepatic tissue, the cell elements of which are markedly

series IX. J

ABSCESS OF THE LIVER.

339

atrophic and granular, or have altogether broken down into fatty or cheesy
debris.

From an Italian seaman, aged 42, who died in hospital from the rupture
of an abdominal aneurism. (“Medical Post-mortem Records,

vol. II, 1877, pp. 543-44.)

285 A section from the right lobe of the liver, exhibiting a circum-
scribed, fibroid nodule, the size of a nutmeg, having at its
centre a small cheesy deposit, and associated with cicatricial-
like thickening of the capsule of the organ,— a “gumma” or
“syphiloma.” — From a native male patient, aged 30, who died
in "hospital from empyema, &c. (See further, “Medical Post-
mortem Records,” vol. III. 1879, pp. 24-25.)

286. “ Abscess of the left lobe of the liver, destroying almost the
whole of its structure, with the exception of a lamina of its
inferior surface. The wall of the abscess is irregular and ragged.”
(Ewart.) No history.

287. An enormous “ encysted abscess of the right lobe of the liver,
forming a cavity large enough to hold a man’s head.” A mere
shell of hepatic tissue is left, especially at the upper and outer
aspects of the abscess-cavity, which are here formed chiefly by
the greatly thickened capsule of the organ and a strongly
adherent diaphragm. The left lobe of the liver remains un-
affected. (Webb’s Pathologia Indica, No. 157, p. 260.)

288. A large ahcess involving the entire thickness of the upper half
of the3 right lobe, leading to great disintegration of the hepatic
parenchyma, and opening through the diaphragm into the right
pleural cavity. (Webb’s Pathologia Indica, No. 1444, p. 261.)
(Presented by Dr. John Macpherson).

289. An enormous abscess of the right lobe of the liver, perforating
the diaphragm, and involving the base of the right lung. The
latter has been considerably destroyed, and participates in the
formation of the abscess-cavity. (Webb’s Pathologia Indica,
No. 555, p. 261.) (Presented by Professor Allan Webb.)

290. “ A large abscess of the right lobe of the liver, opening into the
transverse arch of the colon. The walls of the abscess are held
apart by a glass rod, and the orifice leading into the canal of
the large intestine is plainly observed.” (Webb’s Pathologia
Indica, No. 1535, p. 262.)

291. “ Liver showing an encysted abscess on the convex surface of

the organ, at the junction of the right with the left lobe, and
reaching anteriorly to the situation of the round ligament. It
is about as large as an orange. * * * * There is a good

deal of opacity and thickening of the capsule on every side of
the abscess-cavity.” (Ewart.)

292. “ Liver and a portion of the right lung adherent to the dia-
phragm. In the liver there is the cavity of an abscess, which
contained about a pint of grumous pus. The abscess had
formed a communication with a bronchial tube, which led
directly into the right bronchus. From a native, admitted in
a moribund state.” (Ewart.)

340

ABSCESS OF THE LIVER.

[8EEIES IX.

293. Abscess of the left lobe of the liver, rupturing through the
diaphragm into the pericardium. The communication is indi-
cated by a thick glass rod. The pericardial cavity was found
full of pus, and the membrane itself still shows traces of
inflammatory exudation, so that apparently some pericarditis
had existed (probably from the extension of the hepatic inflam-
mation by direct continuity of tissue) prior to the final rupture
of the abscess, which proved fatal. The patient, a European
male, aged 30, had acquired fever and dysentery in Abyssinia,
and suffered from diarrhoea on the voyage to Calcutta. On
admission into this hospital he was greatly prostrated, com-
plained of intense pain over the left side of the chest, and had
much distress in breathing. He died suddenly from the rupture
of the abscess.

294. A preparation exhibiting an abscess cavity, the size of a foetal
head, which occupies the whole thickness of the upper two-
thirds of the right lobe of the liver. The outer, upper, and
greater part of the anterior walls of this cavity are formed by the
thickened capsule, with only a thin shreddy layer of hepatic
substance. Below and behind, a thick capsule of dense connective
tissue marks the boundary between the cavity and the unaffected
liver parenchyma. The inner surface of the former is soft
and ragged. It contained about ten ounces of thin, slightly
greenish pus.

During life the abscess was punctured in two places by trocar and
canula ; once very directly, but, on the second occasion, obliquely,
as shown by the position of the drainage tube (introduced imme-
diately after puncture). The latter may be seen to pass through
a very considerable thickness of liver-substance before reaching
the abscess. This second operation was rendered necessary on
account of the rapid refilling of the abscess after the first.
Unfortunately, however, acute peritonitis followed, to which
the patient, a native male, aged 30, succumbed. This is the
only abscess in the liver.

295. A preparation showing the rupture of an hepatic abscess into
the stomach. The under surface of the left lobe of the liver
is adherent to the stomach near its lesser curvature and oesopha-
geal end. Here, a rounded opening is seen, about two inches
in diameter, leading from the stomach into an abscess-cavity in
the liver, about as large as one’s fist. The margins of the
opening, on the ventral side, are smooth and sharply-defined. The
inner surface of the abscess is soft, sloughy, and shreddy. The
stomach was found about half full of thick, greenish-yellow pus.
The rupture was, therefore, recent and sudden. No other abscess
was found in the liver.

The patient, a native male, aged about 30, had been suffering for two
months continuously from fever, pain in the hepatic region,
and dysentery. No evidence of the abscess was obtainable
during life. ( See further, “ Medical Post-mortem Records,” vol.
I, 1875, pp. 629-30.) ( Presented by Professor R. C. Chandra.)

SEBIES IX.]

ABSCESS OF THE LIVER.

341

296. A preparation showing a very large solitary abscess of the right
lobe of the liver, perforating the diaphragm, and involving the
base of the right lung. The lower two-thirds of the inferior
lobe of the lung have been more or less destroyed ; a commu-
nication established between the abscess-cavity and several large
bronchial tubes, and, by this means, large quantities of pus were
expectorated during life. On post mortem examination about
two pints of thick, curdy, reddish-yellow pus were found in the
abscess-cavity.

There were no dysenteric lesions, the mucous membrane of both large and
small intestine was healthy. — From a native male patient, aged
25, who died in hospital. (See further, “ Medical Post-mortem
Records,” vol. I, 1875, pp. 937-38.)

297. A section from the left lobe of a greatly enlarged and highly
fatty liver, showing the presence of a circumscribed old abscess,
the size of a pigeon’s egg, discovered post mortem. The abscess
wall is thick, fibrous, and opaque. Its contents consisted of thick,
putty-like, caseating pus. It is situated about two inches below
the anterior surface and upper margin of the left lobe. — From
an East Indian female, aged 36, who died from chronic
dysentery.

The preparation illustrates the occasional fortunate termination of an
hepatic abscess, — i.e., by inspissation and caseation of its contents,
and cotemporaneous contraction and thickening of its walls.

. 298. A portion of the right lobe of the liver with an encysted cavity,
the size of a walnut, which was found filled with thick, yellowish-
white, putty-like material (curdy pus), and represents, therefore,
the remains of an old solitary abscess of the liver.

Found on post mortem examination of the body of a native male, aged
30, who died from chronic catarrhal pneumonia.

299. “ A tumour from the liver of a male prisoner in the jail at Rawul

Pindi. The patient had suffered from fever during the epidemic
of 1873. It is very hard, and seems to have undergone calcareous
degeneration, consisting almost entirely of a mass of chalky
material.” J

The “ tumour ” is a mass the size of a hen’s egg, found imbedded in the
liver substance. Incised, it is seen to consist of a thin shell of
calcareous matter enclosing pulpy, soft, caseous material. The
caseous substance is semi-solid, and like putty. There is also a
little fluid debris, which is distinctly purulent. Examined
microscopically, these contents consist of hepatic cells in various
degrees of atrophy and degeneration, a large quantity of altered
pus cells, and much fat in granules and molecules. The capsule
exhibits traces of a fibrous structure, but, the greater part is
quite hard and calcified. Sections from the surrounding liver
substance reveal no new or morbid cell-growth. The hepatic
cells are found either quite normal in appearance, or moderately
infiltrated with fatty and dark pigmentary material. The mass
or tumour, therefore, most probably represents the remains of a
circumscribed and solitary hepatic abscess, which has undergone
contraction, with subsequent caseation and partial calcification

342

MULTIPLE ABSCESS OF THE LIVER. [seeies ix.

of its contents. ( Presented by Dr. J. Incc, Civil Surgeon,
Rawul Pindi.)

300. Three encysted abscesses in the liver, — “ one in the left lobe, the
size of a closed fist, another in the right lobe as large as a goose-
egg ; another in the middle lobe close to the cava, the size of a
walnut. The man had also an abscess in the brain.” (Allan
Webb. — Pathologia Indica , No. 809, p. 260).

301. A large abscess of the right lobe of the liver, involving
chiefly its inferior surface and outer margin. Numerous, small,
disseminated abscesses are distributed irrregularly throughout
the rest of the organ. — From a native male, (Mahomedan),
aged 32, who died in hospital. ( See further, “ Medical Posh
mortem Records,” vol. I, 1874, pp. 333-34.)

302. Liver with multiple (pyaemic) abscesses, diffusely scattered
throughout its substance. — From a native male, (Hindu), aged 25.

The liver is enlarged ; its surface is irregular, presenting a series of cir-
cumscribed, yellowish-red, slightly projecting, soft nodules, which
occupy chiefly the upper surface of the right lobe, but a few also,
the left lobe. These vary in size from a pea to a pigeon’s egg,
and on section are distinctly seen to be circumscribed abscesses.
They contain from a few drops to two drachms of thick greenish-
yellow pus. Each is surrounded by a well-marked, dark,
liypersemic zone. The hepatic parenchyma generally, is soft
and abnormally vascular. The entire liver weighed 3lb 13 ozs.
The whole of the large intestine, from the coecum to the anus,
was found in a state of acute, sloughy, dysenteric ulceration.
( See further, “ Medical Post-mortem Records,” vol. I, 1873,

p. 112.)

303. Liver enormously enlarged, and showing numerous abscesses
throughout its substance. The largest of these was diagnosed
during life ; was opened and drained. It is situated in the right
lobe, two inches from its inferior margin. The hepatic surface
here was found strongly adherent to the abdominal wall. In
size this abscess appears to have been about that of an orange,
perhaps a little larger, for it is now evidently in a state of con-
traction, and its cavity was quite empty, showing that the
drainage was most efficient.

Standing out from the surface of both lobes, but particularly of the
left, are numerous circumscribed, smaller abscesses, varying in
size from a hazelnut to a hen’s egg. These have a yellowish-
pink colour, and, circumferentially, a darkly congested margin of
hepatic tissue. They contain thick greenish-yellow pus. On
the under surface of the liver, two other large abscesses may be
observed ; and, on incising the organ, several similar purulent
collections and suppurating foci were discovered, situated deeply
in its parenchyma. Such portions of the liver as are not thus
affected have a soft, greasy appearance and consistency, and much
indistinctness of the lobular structure.

The mucous membrane of the large intestine, from the ccecum to the anus, was
thickened, cedematous, of rosy-pink colour, throughout more or less supe -
ficially excoriated, and, in the descending colon, sigmoid flexure, and rectum

seeies IX.] PYEMIC ABSCESSES OF THE LIVER.

313

there were numerous shallow, pitted ulcers, with much hypertrophy of the
submucous coats. From a native male, aged 30, who died in hospital.

: 304. Diffuse (embolic ?) suppuration of the liver. The organ is larcre.
Its surfaces are covered with minute, opaque- white points or dots
which are also thickly distributed throughout the liver-substancp,
as seen on section. The majority are about the size of a pin’s
head or sago-grain ; a few, by coalescence, as large as a split-pea.

They appear to be minute foci of commencing suppuration, a

droplet of thick puriform fluid being obtainable on puncture
or scraping. In the sigmoid flexure and rectum there were
numerous superficial pitted ulcers and ulcerated patches of
the mucous membrane. — From a native male (Ooriah) patient,
aged 30, who was admitted into the hospital on the 5th Septem-
ber 1877, in a very low and prostrated condition, with pain
over the liver, jaundice, loose bowels, pneumonia of the bases
of both lungs, and a temperature of 10I°F. He died the
following day. (“ Medical Post-mortem Records,” vol II 1877
pp. 551-52.) ‘ ’ ’

•Sections from this liver, examined microscopically, reveal important changes in the
interlobular connective tissue. Here, not uniformly, but at very nu-
merous points, a small-celled infiltration can be seen, and the small "inter-
lobular vessels— particularly the branches of the portal vein— are obstructed
by dark-looking, granular material. The small-celled infiltration is most
abundant in the immediate vicinity of these obstructed vessels and
therefore consists probably of emigrant leucocytes. Their size is
somewhat smaller than that of blood-corpuscles, but perhaps this may
be attributed to a somewhat prolonged preservation of the liver in
pure rectified spirit prior to microscopic examination. From these
pomts, as centres, the cells described are seen to invade sparingly the
margins of the proper hepatic lobules, insinuating themselves between
the flattened polygonal hepatic cells. There appears to be also a,
irritative hyperplasia ot the interlobular connective tissue itself, and a further
contribution thus to the interlobular infiltration. Degenerative changes
are very apparent ,n the proper hepatic (secreting) cells,- notably fatty
infiltration, minute droplets ot oil being very abundant within their pro^
plasm. One or two of the larger suppurating foci being punctured the
material w found to consist of altered blood-cells and dsgZ't l
granular debris ; no true formed pus-cells, nor can pus corpuscles be
discovered among the cell elements composing the interlobular i b
1 iteration. Still, the changes appear to be truly infuSmtS™
close association with the blood-vessels (interlobular) and th<! "a* *• T
evidence of the proliferation of the connective tiiu^
obvious. Probably, the diffuse inflammation of the organ had only reachecUn
early stage, i.e„ prior to the formation of true pus. There sLms to b^
equally strong grounds for believing that these chan-es J f S

embolism of the interlobular veins, Ind ‘°

A section from an enlarged and abnormally hyperaemic livor

showing innumerable minute abscesses and points of commencing
suppuration (pytemic). 1 commencing

•05.

-he breaking down of the proper hepatic cells into “granule-cells” and “ mo* »

344

PERI-HEPATIC ABSCESS.

[semes IX.

the blood-vessels therein distributed, and indicate widespread or diffuse
inflammatory changes.

From a native male, aged 20, who died from acute sloughing
dysentery. ( See further, “ Medical Post-mortem Records ”
vol. Ill, 1879, pp. 369-70.)

306. Sections from the right lobe of the liver, showing multiple
pysemic abscesses, which were thickly distributed throughout
the organ, both at the surface and in the deeper parenchyma.
They vary in size from a pea to a nutmeg, and contain thick,
yellowish pus, or purulent debris. — From a native male,
aged 35, who died from acute general peritonitis, after an
operation for the relief of a strangulated hernia. There were
large, sloughy, dysenteric ulcers in the ccecum and ascending
colon. ( See further, “ Surgical Post-mortem Records,” vol. I,
1880, pp. 677-78.)

307. A circumscribed, superficial, peri-hepatic abscess. The capsule

of the organ is seen to be much thickened. Suppuration has
evidently taken place between it and the surface of the liver.
The latter presents an ulcerated and disorganising condition over
a limited space, about the size of the palm of the hand. Towards
the centre of this space a deeper excavation of the hepatic
parenchyma exists,— a cavity as large as a walnut, — the inner
surface of which has a ragged, shreddy appearence. ( Patho -
logia Indica, No. 337, p. 259.) ( Presented by Professor Allan

Webb.)

308. A circumscribed peri-hepatic abscess, the size of a small orange,
situated just beneath the diaphragm, (with which the capsule of
the liver is closely blended), at about the centre of the superior
border of the right lobe of the liver. The contents of the
abscess are mostly caseous, and traces of a distinct pseudo-
membrane can be seen lining its cavity. It is probable, there-
fore, that the collection of pus had been of considerable duration,
and become, as it were, encysted. The base of the right lung
is adherent to the upper surface of the diaphragm, but
neither of these structures have been perforated by the abscess.
The pleural cavity has not been involved, although the pleura
itself is thickened, and the inferior extremity of the anterior
margin of the lung has been drawn down, and fixed to the
diaphragm almost immediately over the situation of the abscess-
cavity. No history preserved.

309. A large peri-hepatic abscess, occupying the left half of the upper
or convex surface of the right lobe of the liver. The proper
hepatic tissue is scarcely involved ; it is merely exposed, and
the upper strata ulcerated over a rounded space, about two inches
in diameter, at the centre of the more superficial and true abscess.
The latter may be clearly seen to have formed between the liver
capsule and the diaphragm. These structures present a ragged
and disorganised condition. The base of the right lung is
firmly united to the diaphragm over the situation of the abscess.

SERIES IX.]

PIGMENTATION OF THE LIVER.

315

313.

The pleura was not involved. The patient died from rupture of
the abscess into the peritoneal cavity.

310. A preparation showing a large abscess of the left lobe of the
liver, chiefly peri-hepatic. It has perforated the diaphragm, and
opened into the left pleural cavity and into the pericardium.
Acute pleuritis and pericarditis, running a very rapid course,
were thus set up, and proved fatal. From a European
(Irishman), aged 32, who died in hospital. (See further, “ Medical
Post-mortem Records,” vol. I, 1875, pp. 769-70.)

311. Perforation of the diaphragm and pericardium by a peri-hepatic
abscess, situated immediately over the left lobe of the liver, but
apparently, not involving the actual parenchyma of the organ.’
The patient, a native male, aged 40, died from acute (purulent)
pericarditis. ( See further, “ Medical Post-mortem Records ”
vol. II, 1877, pp. 363-64.)

312. Two sections from a well-marked “ nutmeg ” liver. A good
deal of the colouring matter has been washed out owing to long
soakage in spirit. The subject was a native male, aged 25, who
died from chronic valvular incompetency, with much dilatation
of the right chambers of the heart.

Sections from the right lobe of the liver exhibiting a very
pronounced “ nutmeggy ” condition, from intra-lobular congestion
and pigmentation.

The patient, a Hindu adult, died in hospital from acute dysentery
There was much chronic pneumonic consolidation of both lungs.'
Two sections from a darkly pigmented liver (malarial). The
patient, a native male, aged 50, was admitted into hospital in
a moribund condition, suffering from remittent fever. The brain
was similarly pigmented. (See prep. No. 31, Series VIII.) The
spleen weighed nine ounces. J

Portions of a very darkly pigmented liver, found on post-mortem
examination of a case of acute dysentery and intermittent fever
-a native male, aged 22, who died in hospital. Examined micro-
scopically, the pigmentation is seen to affect both the interlobular
connective tissue and the hepatic cells. Within the liver lobules
it is deposited both in the secreting cells and external to them
l he pigment matter is very dark, unaffected by acetic acid, and
of granular, amorphous character. It does not seem to follow
specially the interlobular vessels, but is more or less uniformly
distributed throughout the hepatic parenchyma.

Sections from a very darkly pigmented liver. The whole organ
was softened, and of a dark slate colour. The spleen was ex-
ceedmgly pu py and black, -weighed 14 ounces. The grey matter
of the brain had a leaden colour.— From a native male, aged 18
who died of chronic dysentery. (See further, “ Medicaf Post-
mortem Records, vol. II, 1877, pp. 651-52 )

mmivlr pisrcntata- Porti°"s o£,a Jarkly pigmented (mala-
rial) liver The organ was enlarged; the capsule opaque and

somewhat thickened ; substance soft, and of a very dark slate

colour. The lobular structure is throughout ill defined and

much pigmented. Under the microscope the pigment matter

314.

315.

316

1317.

246

FATTY DEGENERATION OF THE LIVER, [sebies ix.

is seen to be granular and very dark. It both infiltrates the
hepatic cells and lies free amidst them. The spleen was large,
dark, and soft ; and the brain (particularly the grey matter) had
a leaden tinge from similar (pigmentary) changes. (See prep.
No. 32, Series VIII.)

Blood removed from the heart, post-mortem, showed much dark pigment matter,
free or contained within leucocytes (melansemia).

From a native lad, aged 14. (“ Medical Post-mortem Records,” vol. II,

1878, pp. 679-80.)

318. A similar specimen from a native male, aged 35, who died in
hospital from remittent fever. The whole organ was enlarged,
and of an uniform dark slate-grey colour. The spleen weighed
14^ ounces, and was soft and dark. The brain was also pigmented.
(See prep. 33, Series VIII.) (“Medical Post-mortem Records,”
vol. II, 1878, pp. 983-84.)

319. A slice from a very darkly pigmented and fatty liver. The
pigment is deposited in very large quantity, and in a granular form
throughout the lobular structure. It appears to be especially
thick in the hepatic cells at the central portions of the lobules.
There is also extreme fatty infiltration of the liver cells ; others
are found (under the microscope) pale, almost colourless, the
nucleus indistinct, and the margins irregular, crenated, &c. —
From a native boy, aged 12, who died from malarial anaemia
and exhaustion.

320. Hepatitis pigmentata. Sections from an enlarged and uniformly
pigmented liver, which presented throughout, a dark slate or
greyish-brown colour.

The subject was a native boy, aged 14, who died from remittent fever.
The grey matter of the brain generally showed a similar darkened
condition from pigmentation. (See prep. 34, Series VIII.)
(“ Medical Post-mortem Records,” vol. Ill, 1880, pp. 481-82.)

321. “ Enlargement of the liver to thrice its natural size from
engorgement with fat. Its section is of a light yellowish colour,
homogeneous, and showing little or no clear definition of its
elementary or parenchymatous structure.” (Ewart.) (Presented
by Dr. F. J. Mouat.)

322. A section from a highly fatty liver. The whole organ was much
enlarged, — weighed Gib 9i ounces. The capsule is thickened,
and was adherent strongly to the diaphragm. The liver sub-
stance has a lemon-yellow colour ; is very soft and friable ;
greasy to the feel; the lobular structure ill-defined and generally
anaemic.— From a European male, aged 25, of intemperate
habits, who died in hospital from acute peritonitis.

323. A section from the right lobe of a highly fatty (“ drunkard’s ’ )
liver. In the fresh state the whole organ had a pale canary-
yellow colour, and was greatly enlarged (weighing no less than
7 lb) ; was throughout very soft and friable. The lobular
structure highly fatty. The hepatic cells enlarged, swollen,
freely infiltrated with oil granules and globules (as seen under
the microscope).

series ix.] AMYLOID DEGENERATION OF THE LIVER.

347

From a European male, aged 30, who had long suffered from chronic
alcoholism, and died in hospital during an attack of delirium
tremens. (See further, “ Medical Post-mortem Records,” vol. I,
1873, pp. 111-12.)

324. A section from the right lobe of the liver, showing very exten-
sive fatty infiltration combined with incipient cirrhosis of the
organ. The weight of the entire liver was 81b 11 ounces.
Taken from a European male, aged 43, who died from chronic
alcoholism, — the immediate cause of death being acute dysentery.

325. A section from a highly fatty and amyloid liver, showing also
incipient cirrhosis. The entire organ weighed 91b 10* ounces.

On microscopic examination, the lobules of the liver appear shrunken, but there is
not much thickening of the interlobular connective tissue. The parenchyma
is found to be very highly fatty, and, when solution of iodine is applied, it
is very beautifully manifested that the amyloid change affects the middle
and central zones of each lobule, while the peripheral portions and the inter-
lobular tissue are highly charged with fatty globules and molecules.

From a European male, aged 35, who died from syphilitic necrosis of
the tibiae, &c. ( See prep. No. 149, Series II, and “ Surgical Post-
mortem Records,” vol. I, 1877, pp. 871-72.)

326. Sections from the liver, the spleen, one kidney, and some
lymphatic glands, all showing amyloid degeneration.

The firm, homogeneous, wax-like and anaemic appearance of these
structures is still well preserved, although now about sixteen
years in spirit. The reaction with iodine is, however, very faint.
No history. ( Presented by Professor Chuckerbuttv June
3rd, 1805.)

327. Amyloid or albuminoid infiltration of the liver. The organ is
enlarged and heavy. Its borders are rounded. The capsule
a little thickened on the upper surface ; throughout tense and
stretched. The hepatic parenchyma is firm, and, on section has
a pale, amende, and glistening appearance, as if infiltrated with
wax or lard. The test solution of iodine gives a most charac-
teristic (reddish-brown) reaction.

Examined microscopically, the abnormal infiltration or deposit affects
the lobular structure almost uniformly.

Similar changes were found in the spleen, kidneys, intestine, &c.— From
an East Indian (male), who died from chronic dysentery and
had also commencing pulmonary phthisis.

328. Sections from the liver of an American seaman, aged 45, who died

in hospital from pulmonary phthisis. The lobular structure is
fairly well defined ; of a dark-red colour towards the centres of
the lobules, from pigmentation; dull yellowish-white towards
the periphery, from fatty changes; or, in some lobules, semi-trans
parent and glistening from amyloid infiltration, and giving
a distinct reaction with iodine solution. All three forms nf
degeneration— pigmentary, fatty, and amyloid-aro combined
and illustrated in this specimen. The spleen and kidneys we tv
mso “amyloid.’' (“Medical Post-mortem Records” vol n
1878, pp. 729-30.) ’

348

TUBERCLE OF THE LIVEE.

[SEBIES IX.

329. The liver oi an East Indian, containing tuberculous nodules
varying in size from that of a pea to that of a walnut. These
depositions consisted of amorphous granules, shrivelled, small,
angulated, and decaying strumous cells, and a few acicular
crystals. There is also demonstrated in the organ a ragged
cavity, which was originally filled with coagulated blood. There
was found a considerable extravasation of blood into the cavity of
the peritoneum — probably the result of violence.” (Ewart.)

The nodules referred to are more or less strictly circumscribed, smooth, and homo-
geneous on section. Under the microscope they exhibit a true lymphoid
structure, consisting of large numbers of small round cells in a scanty
intercellular stroma The growth is seen to invade the lobules at their
peripheries, and gradually extends towards their centres, compressing, dis-
placing, and causing atrophy of the proper hepatic cells. The growths are
probably leukannic in origin; their structure is certainly lymphomatous.

330. Liver, dillusely infiltrated with nodules of varying size, situated
principally near or upon the surface. They are soft, yellowish-
white, not distinctly circumscribed, and present,, under the
microscope, a lymphoid structure— small, nucleated, round cells,
in a delicate but distinct, narrow-meshed reticulum of connective
tissue. The spleen, kidneys, mesentery, and diaphragm, were
all similarly affected. Probably an example of lymphadenoma
or Hodgkin’s disease.

The patient, a native female, aged 40, was admitted suffering from
anaemia, and had a slight gonorrhoeal discharge. She died,

apparently of exhaustion or asthsenia on the tenth day. The
growths were not suspected or evidenced during life, — they

were only discovered post mortem.

331. The liver of an East Indian (male) patient, aged 35, who died

from general miliary tuberculosis. The organ is large, soft, and
flabby. The whole of the right and left lobes are diffusely

infiltrated with minute tubercles, situated both superficially, just
beneath the capsule, and also deeply, throughout the parenchyma.
They consist of yellowish-white granules, each about the size of
a large pin’s head. The liver substance is preternaturally

anaemic, and its lobular structure ill-defined.

The spleen and kidneys were found similarly affected.

332. Liver with numerous caseous nodules (tubercular). The organ
is somewhat small, and of a peculiar dark-slate colour. The
capsule is thin and transparent, except over the surfaces of
certain circumscribed yellowish-white nodules, which are seen to
project slightly from the surface of the liver, on both its upper and
lower aspects. These nodules, on incision, are seen to consist of
small caseous masses, varjung in size from a pea to a chestnut,
and similar deposits are found scattered, irregularly, throughout
the hepatic parenchyma. A few lymphatic glands at the
transverse fissure were found enlarged and similarly cheesy.

Examined microscopically, the centre of each nodule consists of a fatty, granular
debris only. At the periphery, the structure is purely lymphoid, — small
round cells in an indistinctly fibrillated stroma. The hepatic cells in the
immediate vicinity are infiltrated with fat, and many are atrophied and
partially hyaline.

SERIES IX.]

CARCINOMA OF THE LIVER.

349

From a native male, aged 20, who died in hospital.

333. “A liver illustrating many deposits of medullary carcinoma.
The whole organ is more or less involved, and large nodular pro-
jections of the cancerous material are observed on the convex
surface.” (Ewart.) No history. The structure, on microscopic
examination, is found to be typically medullary or enkephaloid.

334. Enkephaloid carcinoma of the liver. From a native female,
aged 60.

The whole organ is much enlarged. The surfaces are nodulated and
covered with flattened outgrowths, which vary in size from a pea
to a hen’s egg.

The majority of these are distinctly circumscribed, flattened at the
centre, raised and' rounded at the margin. They are soft in
consistency. The substance of the liver is infiltrated diffusely
with similar growths.

Microscopic examination shows that their structure is cancerous (enkephaloid).
The cells are large, irregular, and nucleated. The nodules are highly
vascular and also bile-stained, and hence present (in the fresh state,) a
very brilliant reddish-yellow appearance.

The adhesion and thickening of the capsule of the liver over the
peripheral nodules, and their " umbilication” in consequence, are
well marked.

The patient was admitted into hospital on the 2nd, and died on the 10th July 1873.
She stated that four months previously she first noticed a painful and
hard lump in the epigastrium. Since then it has rapidly increased, and
become very tender on pressure. There was constipation, vomiting after
meals, and a burning pain at the pit of the stomach. She was much
emaciated and slightly jaundiced. The liver was felt to be enlarged,
nodulated, and hard. Carcinoma was diagnosed.

335. A magnificent specimen of enkephaloid carcinoma of the liver.
The organ is greatly enlarged, and was found adherent to the
diaphragm above, the stomach, pancreas, and colon below.
Both surfaces are nodulated. Opaque yellowish-pink tubers
are seen projecting just beneath the capsule. They vary in
size from a turkey’s egg to a nutmeg. The left lobe of the
liver seems to be especially involved, but both lobes are exten-
sively infiltrated throughout their whole thickness.

The small portions of the hepatic parenchyma remaining unaffected are
paler than normal, and apparently fatty. The gall-bladder is
also involved, and its coats much thickened.— From a native male
patient, aged 55. (See further, “ Medical Post-mortem Records ”
vol. I, 1873, pp. 249-50.)

336. Scrirhus carcinoma of the liver. From an aged Armenian, who
died in hospital. The organ is somewhat enlarged. Its surfaces
are remarkably irregular and uneven owing to the presence
of numerous, more or less circumscribed, nodulated growths,
varying in size from a pea to a walnut. They are raised
two or three lines above the general surface, are irregularly
rounded and tuberculated at their margins; depressed and
umbilicated at their centres. Each separate nodule is, as a rule,

350 CARCINOMA OF THE LIVER. [series ix.

surrounded by small secondary infiltrations. The growths
reach, for a varying depth, into the hepatic parenchyma, which
is generally soft and fatty. The liver weighs 31b 15| ounces.

Both stroma and cells are well marked in sections examined microscop-
ically, but, from the greater density and abundance of the former, as
compared with that usually met with in enkephaloid of the liver, and
from the more uniform character and comparatively small size of the
cell-elements grouped together within the alveoli, these growths appear
to be more strictly referable to scirrhus than enkephaloid cancer. —
(“ Medical Post-mortem Records,” vol. II, 1877, pp. 373-74.)

337. The liver of a European male, aged 50, showing extensive
infiltration with cancerous nodules (enkephaloid). These affect
the superior or upper surface of both lobes, and particularly the
inferior surface of the left lobe, where, one nodule may be
observed, quite as large as an orange, formed by the coalescence
of several smaller. The majority of the growths are, however,
isolated, and have a very characteristic appearance. They
project two to three lines from the surface of the organ, have a
hard, irregularly-rounded margin, with a zone of dilated injected
vessels and flattened umbilicated surfaces. The colour is dull
pinkish-yellow. The consistency, on section, is soft. The
nodules extend for a variable distance into the hepatic paren-
chyma. The other abdominal organs were not affected, except
the oesophageal end of the stomach, which was considerably
thickened and softened from similar cancerous infiltration.

On microscopic examination the naked-eye appearances of these growths are
confirmed. Masses of large epithelial-looking cells, with two or three
large and distinct nuclei, in a state of rapid proliferation, and granular
from fatty infiltration, are seen taking the place of the normal hepatic
cells. They are grouped irregularly in a delicate alveolated stroma, formed
evidently at the expense of the already existing connective tissue of the
liver ; the proper gland cells are displaced, and appear atrophied and
degenerate.

338. Enkephaloid carcinoma of the liver. The organ is a little
enlarged and much nodulated. The nodules vary in size from an
orange to a walnut. They project from the surface, are of
yellowish-white colour, their free surfaces flattened and consist-
ency soft, especially towards the centre of each nodule. They
affect the right and left lobes and the lobus quadratus, are also
found in large numbers in the deeper hepatic parenchyma.

Examined microscopically, their truly cancerous structure is very distinct. A
delicate connective tissue stroma is found, filled with polymorphous
nucleated cells, undergoing rapid fatty metamorphosis.

From a Hindu female, aged 40. The left ovary was similarly affected.
(See further, “ Obstetric Post-mortem Records,” vol. I, 1879,
pp. 595-56.)

339. Carcinoma of the liver. The surface of the organ is rough and
nodulated, covered with button-like projections of a deep-yellow
colour, strictly circumscribed, more or less rounded, and with
umbilicated centres. These vary in size from half a walnut to a

SERIES IX.]

CARCINOMA OF THE LIVER.

351

pea. On section of the liver, two enormous masses are found
just below the surface, occupying the whole thickness of the right
lobe, from the inferior margin to the middle third. They have a
deep orange-red colour (in fresh state), cut very firmly, and
have a slightly fibroid appearance. The larger one, which is
situated about an inch to the right of the gall-bladder, was felt
during life through the abdominal parietis. It is fully as large
as a turkey’s egg. The smaller is about the size of a hen’s
egg, has similar appearances, reaches the anterior surface, and
interiorly involves the gall-bladder. The latter is firmly con-
tracted, the cystic duet quite occluded. Numerous disseminated
cancerous nodules are found throughout the hepatic parenchyma.
This is true scirrhus of the liver.

The largest nodule exhibits a very fibrous structure under the microscope ; the stroma is
highly developed, fibroid, and nucleated. It forms, for the most part,
small alveoli ; these are filled with epithelial-like nucleated cells of
varying size, but mostly smaller than those found in enkephaloid, and
more uniform (less diversified) in shape. The fibrous decidedly predom-
inates over the cellular structure, and the cancer is therefore probably of
some standing, and of comparatively slow growth,— all of which characters
belong to scirrhus.

From a Mahomedan female, aged 45, who died in hospital. (See fur-
ther, “Medical Post-mortem Records,” vol. II, 1877, pp. 357-58.)

340. Scirrhus carcinoma of the liver. A section from the left lobe
of a liver which was enormously enlarged from cancerous
growth. The entire organ weighed 12ft \2\ ounces. It occupied
the upper-half of the abdominal cavity, reaching downwards
to the level of the umbilicus. Both upper and lower surfaces
of the organ (see preparation) have a broadly nodulated
appearance, and are seen diffusely infiltrated with prominent
tumours of a yellowish-pink colour and firm consistency.
They vary in size from a pea to a potato. The majority are
intimately connected with the capsule ; and, while their mar-
gins are rounded and tuberculated, their surfaces are flattened,
smooth, and more or less umbilicated. Both margins and
surfaces are highly vascular. Over the latter, delicate capillary
vessels may be seen ramifying.

Sections examined microscopically display very typically all the characters of true
scirrhus carcinoma. Both stroma and cells are found well developed, and
the gradual transformation of the proper hepatic tissue into cancer struc-
ture is very well marked at the periphery of the nodules. The specimen
is a well marked example of primary scirrhus of the liver.

The subject was an East Indian woman, aged about 40, who was
brought to the hospital in a moribund condition, and died
within twenty-four hours of admission.

341. A portion of the left lobe of the liver, with a large (secondary)
cancerous deposit, situated at about the centre of this lobe. It
is about the size of a hen’s egg, and is soft and brain-like in
both consistency and colour (in the fresh state).

352

CARCINOMA OF THE LIVER.

[SERIES IX.

On microscopic examination all the characters of enkephaloid carcinoma are ex-
hibited,— an infiltration, or rather transformation of the hepatic cells into
polymorphous, nucleated, epitlielial-like cells, placed in imperfectly developed
alveoli (stroma). The structure of the latter is most pronounced in the
| vicinity of the interlobular spaces, it being probably a development from
the normal connective tissue here. The cells are of varying size, many are
caudate and spindle-shaped. The nuclei are large and well defined, single
or double. The adjacent non-aftected hepatic parenchyma shows fatty
infiltration of the cellular and intercellular structures. In the boundary
line between the two, the gradual transformation of liver-cell into cancer-
cell is very beautifully seen. This process apparently consists (roughly)
of a swelling up of the protoplasm, with subsequent division of the
cell (hepatic) into ' Segments, which form independent cancer-cells or
nuclei.

From a European, aged 43, who died from enkephaloid carcinoma of the
right testicle. The lumbar glands were infiltrated, and secondary
deposits were found in the lungs as well as in the liver. (See fur-
ther, “Surgical Post-mortem Records,” vol. I, 1875, pp. 237-38.)

342. Liver thickly infiltrated, both at the surface (just beneath the
capsule), and also throughout the parenchyma, with deposits of
melanotic soft cancer. These vary in size from a pea, or even
smaller, to a walnut. Similar deposits were found in the brain,
kidneys, bones, &c.

On microscopic examination, their structure is found to he truly cancerous.
Both cells and stroma are well marked and easily identified.
The latter is delicate and scanty, and is infiltrated, as well as the
cell elements, with dark, granular pigment. — From an East
Indian male, aged 41. (See further, “ Medical Post-mortem
Records,” vol. I, p. 16.)

343. A portion of the right lobe of the liver, with a soft, rounded
growth, of brain-like consistency and appearance. It is about
the size of an orange, and situated about a third of an inch below
the convex surface of the organ.

Taken from a native female, aged 27, who died from exhaustion conse-
quent upon the return in situ, for the third time, of a large
round-celled sarcoma of the right mamma.

Sections from this hepatic growth exhibit a very disintegrated oily condition of
the liver lobules, with an infiltration of more or less rounded or oval cells.
They have large single or double nuclei, and a granular protoplasm. There
is no intercellular formed tissue or stroma. The growth or deposit is
evidently, therefore, sarcomatous. There was a small similar deposit in the
right lung.

344. A thin-walled simple cyst of the liver as large as a walnut. No
history. (Webb’s Patholor/ia Indica, No. 333, p. 257.)

345. A similar specimen, and of about the same size. The inner
surface of the cyst is encrusted with calcareous deposit.
(Webb’s Patholor/ia Indica, No. 336, p. 257.)

346. A simple cyst, the size of a pigeon’s egg, situated on the upper
surface of the liver, at the inferior extremity of the suspensory
ligament. It was found filled with soft, cheesy material ; no
hydatid structure.

series IX.]

HYDATIDS OF THE LIVER.

353

347. A section from the right lobe of the liver showing a serous
cyst, the size of an orange, situated near the upper margin,
close to the suspensory ligament. It contained opalescent, thin
fluid, and has a distinct glossy lining membrane. It is bounded
on three sides by liver parenchyma, in front by the thickened
capsule only, which was adherent to the diaphragm. No other
cyst was found in the organ, the general structure of which was
soft and fatty. — From a native female, aged 38, greatly emaciated
by chronic dysentery. (“ Medical Post-mortem Records,” vol. II,
1878, pp. 715-16.)

348. “ A calcareous deposit enclosed in a cicatrix-looking substance,
which is continuous with the parenchyma of the liver. The
hepatic structure is a good deal puckered all round the concre-
tion.” (Ewart.)

On making a section through this so-called “ calcareous deposit,” the
true nature of the same is at once revealed. The calcareous
matter forms a mere shell, two to three lines in thickness, and
is undoubtedly a degenerated hydatid cyst. It contains several
dead and withered echinococci. — From a European soldier,
“ Private Robert Whiskin, Her Majesty’s 15tli Hussars, aged
39 years,” who died from cholera. ( Presented by Dr. J. Mouat,
Inspector-General, Madras.)

.349. “A fine specimen of hydatid of the human liver, as large as a
closed fist, projecting beyond the free edge of the liver,
parallel with the gall-bladder, close to it, but on the right side.”
(Allan Webb .) — (Patholoyia Indica, No. 769, p. 257.)

350. A portion of the right lobe of the liver with two large hydatid
cysts. One is the size of the foetal head, occupies almost the
entire thickness of the right half of this lobe ; its walls are
thick and leathery, and it is filled with echinococci, varying in
size from a pea to a walnut. The other cyst is flattened,
situated at the superior border of this lobe ; its walls are also
much thickened, and the degenerate acephalocysts in its interior
are imbedded in much cheesy or sabulous material. ( Presented
by Professor Edward Goodeve.)

351. A portion of the right lobe of the liver of Alexander Burns, a
a Scotchman, Chief Officer of the B. S. Newark, showing
(1) an enormous hydatid cyst, situated on the anterior and outer
aspect of this lobe, and occupying a considerable portion of the
whole thickness of the organ at this part. This cyst suppurated,
and was aspirated during life. (2) A second, rather smaller
hydatid cyst on the posterior aspect of the same lobe, not
communicating with the anterior cyst, and found on post-
mortem examination to be filled with clear transparent fluid,
and a large number of echinococci of various sizes. ( Presented
by Dr. C. H. Joubert, General Hospital.)

352. The liver of a Chinaman (AfToo), aged about 20, who was brought
into the hospital in a moribund condition, and died four hours
after admission. No satisfactory history could be obtained
with respect to his illness, as the patient was unconscious, and
his friends merely stated that he had been suffering from

354

DISTOMATA OF THE LIVER.

[semes IX.

“fever ” with some cough, for about a fortnight. The counten-
ance was pale ; conjunctiva) jaundiced ; pulse barely percept-
ible at the wrist ; abdomen full, hard, and tense.

The liver is enlarged, and its biliary ducts are obstructed by numerous
distomata ( Distoma sinense ).

The following note of the condition of the organ, in the fresh state, was recorded at
the post-mortem examination (9th September 1874) : —

The liver is enlarged, of a dark-purplish or slate colour superficially, soft and
muddy-looking on section. The portal and hepatic veins are loaded with
fluid dark blood. The bile-ducts are filled with thick, yellowish, inspissated
bile, and, on slitting them up, numerous small vermicular bodies (distomata)
are found obstructing tbem, and are removed in large numbers. The gall-
bladder is distended, the bile thick, of orange-yellow colour, measures about
If ounces. No distomata in this fluid, and none found in any part of the
alimentary canal or its contents.

The distomata thus found were ascertained to be of a new species ; they were des-
cribed and delineated, and an account of the discovery published in the
Lancet, August 1875, reproduced in the Veterinarian, October 1875.
Specimens were sent to Dr. Spencer Cobbold, of London, who proposed the
name of Distoma sinense for this new fluke, by which it is now known.

The preparation is interesting, as being the first recorded “find” of this
species of distoma in man. ( See further, Series XX, for descrip-
tion of distoma, and “ Medical Records vol. 1, 1874, pp. 353-54.)

353. The liver of a native male (Mahomedan), named Jamali Khan,
aged 34, who died from dysentery, &c.

The bile ducts are throughout much thickened and dilated, and numbers
of small distomata are found within them. About a dozen of
these escaped on section of the organ, and about twice this
number were found on dissecting out and laying open the biliary
canals in a portion of the right lobe. The rest of the liver has
been left entire, and it is probable, that all portions are pretty
equally filled with these parasites, because, as far as the dissection
has extended, they can be squeezed out of the open mouths of all
the larger and medium-sized ducts. The liver itself is somewhat
dark, moderately firm. The gall-bladder contained about 1|
ounces of bile, which was thick and yellowish- green. The cystic
duct was free. No distomata were found in the gall-bladder, and
none in the contents of the alimentary canal.

No evidence of the presence of ova can be detected, on microscopic examination, of
bile from the gall-bladder, and of scrapings from its lining membrane. The
lining membrane of the biliary canals is vascular, and its epithelium abun-
dant (catarrh). In the epithelial and coloured debris ova are detected.

1'/ yt

They are of the usual type, and measure X .

Sections from the liver parenchyma show fatty infiltration of the lobular structure,
but not to any marked degree. The bile-ducts are considerably hypertro-
phied, their walls abnormally thick, and epithelial lining shred.

The distomata filling the biliary canals are of the variety known as
Distoma conjunctum, and the preparation has this special interest
attaching to it, — viz. that it is the first known instance or
example of a human liver being infested by these parasites.
Hitherto, they were supposed to be confined to the genus Felts'

SERIES IX.]

DISTOMATA OF THE LIVER.

355

(foxes and dogs.) The discovery was made on the 9th of January
187G. ( See further, Series XX, for description of the distoma, and
the Lancet, March 4th, 1S7G, p. 343 ; also, “ Medical Post-
mortem Records,” vol. I, 1875, pp. 963-64.)

354. Liver fatty and somewhat “ nutmeggy.” The bile-ducts are
prominent, and full of thick yellow secretion ; they are also occu-
pied by numerous distomata, which exhibited, on removal and
placing in water, undulatory movements, indicative of vitality.
( Post-mortem performed three hours after death). One fluke was
also found in the gall-bladder. They belong to the variety
known as D. sinense (. McConnelli ). — From a Chinaman, aged 28,
who died from pulmonary phthisis. (“ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 81-82.)

355. The liver of a Chinaman, aged 40, who died in hospital from
remittant fever. The bile-ducts are dilated, their walls thick-
ened, and their channels occupied by numerous distomata
(D. sinense McConnelli). The general hepatic parenchyma
is dark and hypersemic ; its consistency soft ; the lobular
structure greasy and indistinct.

From one incision in the right lobe of this liver about thirty
flukes were removed. They were found either singly or in
little groups. The whole organ is thickly infested with them.

356. The liver of a Mahomedan, aged 18 (a coolie), who died from
acute dysentery. The bile ducts throughout the organ are more
or less dilated, and their walls thickened. They contain
numerous flukes (distomata). These are found in twos or
threes, or in small colonies of six or eight, coiled upon each
other. Only one was found in the gall-bladder. They are
examples of the JD. conjuctum. (“ Medical Post-mortem Records,”
vol. Ill, 1879, pp. 203-204.)

357. Peculiar malformation of the liver, consisting of the develop-
ment of a kind of middle lobe between the usual right and left
lobes of the organ. This accessory lobe is separated by deep
longitudinal fissures from the lateral lobes. The condition seems
to have been congenital. “From a native female.” ( Presented
by Baboo B. C. Chatterjeo.)

B 358. The liver of a European male, who died in hospital from
pneumonia. The left lobe is exceedingly rudimentary. It is
represented by a small, somewhat tongue- shaped portion of
hepatic parenchyma on the under surface of the left border of
the liver, very indistinctly separated from the right lobe.
The latter is greatly hypertrophied. No “lobus quadratus” can
be distinguished. The suspensory ligament extends along the
left border instead of the anterior surface of the liver ; its
position may he identified by the portion of the round ligament
left in situ. ( Presented by Assistant-Surgeon Gopal Chunder
Roy, Howrah.)

359. Obstruction and compression of the cystic and common eholedic
ducts by a series of greatly enlarged" lymphatic glands. The
gall-bladder is somewhat contracted —probably from the same
cause. No history. (Webb’s Pathologia Inclica, No. 807, p.257.)

356

DISEASES OF THE GALL-BLADDER.

[series IX.

360. Gall-bladder found distended with transparent limpid fluid,
destitute of all colour. It is much dilated, sausage-shaped, six
inches in length, three and a half inches in circumference at the
fundus. ihe cystic duct was obstructed by a gall-stone the size
ol a hazel-nut. ( Presented by Professor Norman Chevers.)

361. Much thickening of the walls, with contraction of the cavity of
the gall-bladder, which was found to contain no fluid bile. The
cystic duct is obstructed (see preparation) by an irregularly
rounded, hard calculus, the size of a nutmeg. The subject was a
native female, aged 20, who died from puerperal peritonitis.
(“ Obstetric yost-mortem Records,” vol. I, 1879, pp. 509-10.)

362. “ The liver and pancreas of a native female, who died in hospital
from diarrhoea (with frequent voiding of round worms). Two
round worms occupied the ductus communis choledochus. Their
heads reach the bifurcation, their bodies hang into the duodenum ”
(Colles.)#

“The stomach was full of gelatinous mucus. The mucous membrane of the
duodenum and upper half of the jejunum intensely injected in patches a foot
long. The gall-bladder contained ten or eleven drachms of dark bile, which
escaped freely on pressure, shewing that the worms did not obstruct the
duct.”

363. A specimen showing the occupation of the hepatic duct and
its branches by round worms (A. lumbricoides) . A section made
into the convex surface of the right lobe revealed numbers of
these parasites protruding from the divided biliary ducts. About
two hundred were found in the intestine. The liver itself is soft
and friable, of deep orange-yellow colour.

“ Under the microscope the hepatic cells were all shrunken in size, had lost their
characteristic granular appearance, and were loaded with large drops of
oil.” (Colles.) ( Presented by Dr. Chuckerbutty.)

364. Rupture of the gall-bladder from a kick on the abdomen. “ The
rupture is at the fundus, and would admit a No. 5 catheter.
The gall-bladder has been opened on the left side, and a blue
glass rod passed through the rupture. It has the appearance of
a clean punched-out hole ; there is no thinning of the coats in
the neighbourhood. The patient was an Irish soldier (Thomas
Downey), aged 27.

He was brought to the hospital on the 17th August^lSTl. by the police, who had
found him in the house of a public woman. He had a slight cut on the
left hand, and complained of violent pain in the abdomen, where, he said,
he had been kicked, but no mark was visible. He gradually sank, and died
on the 19th.” (Colles.) (Presented by Professor J. Fayrer.)

•

365. Atrophy of the gall-bladder, “ apparently from the organization
and subsequent contraction of lymph in and on its parieties. It
is about the size of a large filbert.” (Allan Webb’s Fatholoyia
Indica, No 83d, p. 257.)

* Qnly one worm, nearly separated into two portions, is to .belseen now iniho situation
described.- J. F. l\ McC.

SEBIES IX.]

DISEASES OF THE GALL-BLADDER.

357

366. Dilatation of the gall-bladder from pressure of an enlarged
lymphatic gland upon the cystic duct, producing very great con-
traction and almost obliteration of the same. The choledic duct
remains quite free, and is somewhat dilated.

367. Gall-bladder much elongated and dilated from the impaction of
a mass of irregularly-rounded cholesteric calculi, varying in size
from a mustard-seed to a pea. The cystic duct is pervious, but
a good deal contracted.

368. Dilated gall-bladder and bile-ducts. The walls of the former
are much attenuated— almost transparent. No history.

369. A gall-bladder occupied by calculi. These are about a dozen in
number, facetted, each about the size of a hazel-nut. The nucleus
consists of dark colouring-matter, the crust of mixed phosphates
and cholesterine. The cystic duct is much dilated.

370. Gall-bladder filled with calculi, which are irregularly facetted,
and none much larger than a pea. They are composed of biliary
colouring-matter only. The cystic duct is much dilated.

371. Hour-glass-like contraction of the gall-bladder, the walls of
which are much thickened. Too large cholesterine calculi may be
seen impacted above and below the constricted part. ( Presented
by Professor Allan Webb).

372. A gall-bladder containing a large number of small, brilliantly
white, cholesterine calculi, varying in size from a millet-seed to
a pea. “ Its walls are thrice their normal thickness. The peri-
toneal coat is dull, opaque, thick, and somewhat puckered from
the contraction of organized lymph.”

373. The liver, with a large biliary calculus completely filling the gall-
bladder. It is very dark and hard, and, apparently, chiefly com-
posed of biliary colouring matter. The long diameter of the
calculus measures three inches : it is biconical in shape, and, at
the widest part about an inch and a half. The liver is small and
contracted (cirrhotic).

374. A gall-bladder much contracted and hour-glass shaped. Its
walls are much thickened, and adhere closely to the surfaces of
two rounded, mulberry-looking, rough, cholesteric calculi, each
as large as a pigeon’s egg, which completely fill its cavity. — From
a nativo female patient, aged 27, who died of dysentery'. ’

375. Obliteration of the gall-bladder and cystic duct by biliary con-
cretions which form an irregular, roughened, “ mulberry-like ”
mass, at the fundus. The coats of the gall-bladder at this part
have become calcified and inseparably united to the contained
calculi. The latter are composed of biliary pigment, with a thin
crust of cholesterine.— From a European (male), aged 40, who
died from chronic dysentery, &c. (“Medical Post-mortem
Records,” vol. Ill, 1879, pp. 1-2.)

376. A section from the liver including the gall-bladder. The latter

ulcerated and perforated by impacted gall-stones.— From a
native male, aged 21, brought into the hospital in a moribund
condition, and who died from acute peritonitis, the result of this
lesion. ( See further, “ Medical Post-mortem Records,” vol III
1880, pp. 675-76.) * ' ’

358

DISEASES OF THE PANCREAS.

[series IX.

377. A preparation showing the pancreas and retroperitoneal lymphatic
glands infiltrated by cancerous growth (scirrhus). These
structures formed a mass, the size of two fists, in the epigastrium.
The aorta and the oesophageal end of the stomach were included
in the tumour. The latter was constricted, and, as well as the
whole of the lesser curvature of the stomach, infiltrated with
.tuberous, opaque- white, waxy-looking deposits of the same
character as the main growth.

Sections from all these parts, examined microscopically, exhibit the histological
structure of glandular carcinoma (scirrhus). It is most developed and
advanced in the head of the pancreas; in the retroperitoneal glands is less
marked. All parts show morbid hyperplasia and increase of fibrous tissue;
some, the transition stages frem this condition to true carcinomatous stroma,
with well-defined alveoli and polymorphous, crowded, epithelial cell-
elements.

From an aboriginal New Zealander (a seaman), aged about 25, who
died in hospital. ( See further, “ Medical Post-mortem Records,”
vol. II, 1877, pp. 569-70.)

378. Scirrhus carcinoma of the pancreas. The head of the gland is
enlarged and indurated. It presses upon and obstructs the
common choledic duct at its termination in the duodenum.
There is a good deal of thickening of the mucous and sub-
mucous tissues at the pyloric end of the stomach, and the peptic
glands and follicles here situated are enlarged and swollen, but
free from cancerous infiltration (examined microscopically).
Sections, however, from the pancreas reveal a true scirrhus
structure. — From an East Indian (male) patient, who died in
hospital (with marked symptoms of obstructive jaundice.)

379. Cancer of the pancreas. From a native prisoner, Moosai Kunjur,
aged 30. The disease involved the stomach, a portion of the
liver, the right kidney, and the spleen ; also, the mesenteric
glands. All these formed a large nodulated mass, occupying
the upper half of the abdominal cavity. The head of the pan-
creas is enlarged to about three times its normal size, and the
whole bulk of the gland is much increased. Its outline is
nodulated, but soft and succulent, and, on section, spongy. Much
thick mucoid fluid escapes from the cut surface.

Thin sections from various parts of the organ, but especially from the head, swell
up enormously when floated in water, and some are thus completely disin-
tegrated. When examined microscopically, a distinct, but delicate stroma of
fine connective tissue is seen forming more or less rounded spaces or alveoli,
which are filled with large, round, epithelial cells, undergoing rapid colloid or
mucoid metamorphosis. Some of the alveoli are almost destitute of cell-
elements, merely filled with glistening, mucilaginous-looking material, or the
same with fragments of degenerated cells. The same material is seen infil-
trating, in parts, the stroma, and giving it an cedematous, softened, and
swollen appearance. The structure is therefore typically carcinomatous,
but of the colloid variety.

{Presented by Dr. Shirley Deakin, Superintendent, Central Jail, Allaha-
bad.)

380. Pancreas with two large bloody extravasations (apoplexies or
infarctions) occupying the head of the organ. One is about the

SERIES IX.]

PANCREATIC CALCULI.

359

size of a walnut, the other rather smaller. They are, for the
most part, soft and dark, a little laminated and decolourised at
the periphery only. Similar hsemorrhagic “ blocks” were found
in the spleen and kidneys ; there was also a large blood extra-
vasation into the left middle lobe of the cerebrum ( see prep.
No. 6, Series VIII). — From an Armenian (male), aged 20, who
died from acute valvular endocarditis, &c. (prep. No. 102,
Series VI).

381. A preparation showing an enlarged and swollen condition of the
pancreas, which crepitates on pressure. This condition is due
(as seen on dissection) to great dilatation of the pancreatic
duct, from the tail to the head of the organ, and its occupation
by greyish-white calculi. These vary in size from a hazel-nut
to a pea ; besides which, considerable calcareous debris fills this
channel, and also, some thick milky fluid — inspissated pancreatic
juice.

Found on post-mortem examination of the body of an aged Hindu,
(iEt about GO), who died from dysentery. {See further, Appen-
dix to Post-mortem Records, vol. II, 1878.)

CATALOGUE

Off THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PART VI.

INJURIES AND DISEASES OF THE SPLEEN,
THYROID GLAND, SITPRA-RENAL
CAPSULES, AND LYMPHATIC GLANDS.

INJURIES AND DISEASES OF THE KIDNEYS

AND URETERS.

Series X and XL

/»

✓

/ ■

t ' •

SERIES X.]

INDEX.

363

Series X.

INJURIES AND DISEASES OF THE SPLEEN,
THYROID GLAND, SUPRA-RENAL
CAPSULES, AND LYMPHATIC GLANDS.

INDEX TO THE SERIES.

A.— THE SPLEEN—

1. — Rupture, 1, 2, 3, 4, 5, 6, 7, 8.

2. — Removal of a portion by ligature, 9.

3. — Hypertrophy : — v

(a) Acute (hypersemicj, 10.

( b ) Chronic (malarial), 11, 12, 13, 14, 16, 16, 17, 18.

4. — Atrophy, 21, 22, 23, 24, 25, 26.

5. — Thickening of capsule, 11, 15, 16, 19, 27, 28, 29, 30, 31, 54.

6— Inflammation and its consequences (including abscess), 32, 33,

34, 35, 36, 37.

7. — Cirrhosis, 38, 39, 40.

8. — Infarctions

(a) Simple, 41, 42, 43, 44, 45.

( b ) Pysemic, 46, 47.

9. — Morbid infiltrations and growths : —

(a) Amyloid or albuminoid, 48, 49, 60, 51, 52, 53,

Series IX).

(5) Pigmentary, 16, 56, 56, 57, 58, 59, 60, 61.

(d) Cretaceous, 66.

(e' Lymphadenoma (Hodgkin’s disease), 67, 68.

(/) Cystic, 69.

10. — Malformations

(a) Abnormal Assuring or lobulation, 70, 71, 72.

(6) Accessory spleens, 16, 71, 73, 74, 75.

11. — Specimen from an Ourang-Utan (Simia Satyrvs), 76.

54 (326,

364

INDEX.

[semes X.

B. — THYROID GLAND-

1. — Hypertrophy, 77, 78, 79.

2. — Mobbid gbowths :* —

(a) Fibroid, 80.

(i) Cystic, 81, 82, 83, 84.

C. — SUPRA-RENAL CAPSULES—

1. — Mobbid gbowths : —

(a) Fibroid, 85, 86.

(5) Carcinomatous, 87 (melanotic).

D. — LYMPHATIC GLANDS—

1. — Mobbid infiltbations and gbowths :* —

(a) Scrofulous or tubercular, 88, 89.

(b) Amyloid or albuminoid, 326 Series IX.

(cl) Carcinomatous, 91, 92, 93, 94, 95.

(f) Sarcomatous, 96, 97.

(/) Syphilitic, 98.

(g) Pigmentary, 99.

E. — THYMUS GLAND—

1- — Nobmal hypeeteophy in young infant, 100.

2. — Abnobmal pebsistence of, 101, 102.

F. - PINEAL GLAND-

1. — Pseudo-cystic hypeeteophy, 103.

• See also Series XVII.

1 Spleen of an artillery corporal ruptured. The patient “ had received
a severe fall on his left side the day before his admission into
hospital.” The rupture extends through almost the entire thick-
ness of the organ, running transversely from within outwards,
about two and a half inches below the head or upper extremity of
the spleen. The organ is enlarged, its texture very soft and friable.
( Presented by Mr. Leckie.)

2. “ An enlarged spleen, ruptured by a blow after a meal, or when the

stomach was full. I he capsule has been cleanly torn, but the
parenchyma underneath is ragged and uneven.” (Ewart.) The
rupture alluded to is almost an inch and a half long, transverse
in direction, and situated at the posterior or left margin of the
superior extremity of the spleen.

3. “ An enlarged and softened spleen, on the under surface of which

is a gaping chasm, penetrating deeply into the substance of the
organ, running transversely from the inner margin, and upwards

8EEIE9 X.]

RUPTURE OF THE SPLEEN.

365

of two and a half inches in length. The rupture of the capsule
is not straight, and there is slight unevenness in its margins.
£he splenic parenchyma, however, is ragged and irregular, and
between the two walls of the chasm there is a portion of pulp
and coagulum interposed.” (Ewart.) No history. (Presented by
Dr. W. Gr. Ellis of Patna.)

4. “ Ruptured spleen.” No history. The organ is large and swollen.

A jagged rent extends obliquely across the whole of the outer
or convex surface, from the superior to the inferior margin, and
taking a direction from above, downwards and outwards.

( Presented by Professor Chuckerbutty.)

5. Spleen showing a double rupture at the anterior margin, near

the inferior pointed end of the organ. The lower rupture is an
inch and a half in length, and comparatively superficial. Tliree-
fourths of an inch above it is the second fissure, half an inch in
depth, and reaching the hilum internally. The whole organ
presents a shrunken appearance. The capsule is much wrinkled.
From a native (Ram Lall), who fell off a tamarind tree, a height
of from 20 to 30 feet, and sustained, besides the above injury,
a rupture of the kidney ( see No. 3, Series XI), and a compound
fracture of both bones of the forearm. ( Presented by Professor
J. Fayrer.)

6. A ruptured spleen. The organ is enlarged to about twice its

normal size. The outer smooth surface and inner scolloped margin
show a series of lacerations of the capsule extending for a vari-
able distance into the substance of the organ. The deepest is
at the superior extremity, where the splenic substance has
• broken down and presents a shreddy, disorganised condition for
a depth of at least two inches.

Taken from an adult native, a mason (raj), who, while engaged in
some repairs to the southern fa9ade of the hospital, missed his
footing and fell to the ground, a distance of about 40 feet. He
was picked up almost insensible and completely collapsed, and
died two hours after the accident.

7. Rupture of the spleen. There are four lacerations on the under

surface of the organ, two of which, near its inferior margin,
reach the hilum, and are each about an inch and a half in length
and hall an inch deep. The other twro fissurings are near the
upper part of the posterior margin, and are more superficial.
The entire organ weighs 21 ounces, is large and soft.

The deceased (a Mahomedan), named Shaikh Baboo, was said to have
been beaten by two East Indian lads.

At the post-mortem examination (24 hours after death) several pints
of blood were found in the peritoneal cavity. ( Presented by
Dr. Mackenzie, Police Surgeon.)

8. Extensive rupture of the spleen, the result of a kick on the side.

The organ is enlarged, very soft and pulpy. On its anterior or
outer surface, at about the lower third, a deep transverse lacer-
ation is seen, passing almost completely through the whole
thickness of the spleen. It is crossed by a longitudinal fissure
which ruptures the capsule, extends upwards and outwards

366

HYPERTROPHY OF THE SPLEEN.

• [9ERIES X.

to within half an inch of the posterior margin, near the upper
extremity, and, below the transverse laceration, extends com-
pletely through the whole thickness of the inferior extremity of
the organ. On the posterior aspect of the spleen two other
transverse lacerations are seen, both a quarter of an inch deep,
running transversely inwards from the posterior margin towards
the hilum, which indeed is reached by the lower of the two.
The subject of these injuries was a native (Mahomedan) lad,
aged 16.

9. “ A portion of the spleen which protruded though an incised

wound in the abdomen, and was removed by ligature. The
patient did well.” (Colles.) ( See further, Indian Medical
Gazette, April 1868.) {Presented bg Dr. Hyatt, Civil Surgeon,
ltanchi.)

10. An enlarged, soft, and dark spleen. From a case of enteric

(typhoid) fever — a Hindu boy, aged 8« ( See prep. No. 95,

Series IX.)

11. “ An enormously enlarged spleen taken from a patient suffering

from what is called spleen disease, with intermittent fever. The
organ is somewhat larger than an ordinarily sized liver, and has a
division into two lobes. Its peritoneal covering is marked here
and there with patches of lymph, and the peripheral structure
of the organ beneath the investing membrane is, for an extent
varying from one to two inches, very much condensed— like
liver.” #****“ The centre of the organ is occupied
by a tissue of loose and flocculent capillary vessels, floating like
moss and resting upon irregular loops about as thick as hair.”
(Allan Webb.) * {Pathologia Indica, No. 556, p. 142.) *

12. Chronic (malarial) enlargement of the spleen. The organ is

increased to about three times its normal size. The capsule is
throughout thickened, opaque, and leathery, the surface corru-
gated and coarsely granular. The cut surface is more or less
homogeneous and firm, particularly towards the periphery, where it
has a condensed appearance for a depth of from half an inch to
an inch. (Webb’s Pathologia Indica , No. 680, page 143.)

13. “ Enlargement of the spleen, taken from a girl who had been a

sufferer from sloughing ulceration of the labia and the soft
parts over the pubis. The capsule and peritoneal investments
are much thickened from organized lymph exudation. The
section demonstrates about half an inch of the peripheral paren-
chyma to consist of dense hepatic-looking structure, so com-
pactly arranged as to preclude the possibility of distinguishing
any of the trabecular spaces with the unaided eye. Within this
lamina the fibrinous prolongations of the capsule are more
manifest, and near the centre of the organ they are hanging
forward loose and in a measure devoid of the spleen- pulp, which
has here escaped during maceration.” (Allan Webb.)

14. “ Enlargement of the spleen. Its capsule is thickened, opaque,

and slightly puckered 'from contraction of the exuded lymph.
The parenchyma is in some parts tolerably even and regular,
but it is generally of a honeycombed character, from the escape

SERIES X.]

HYPERTROPHY OF THE SPLEEN.

367

of the pulp contained in the enlarged trabecular spaces during
maceration.” (Ewart.)

15. Two firm, chronically enlarged spleens. The capsules are much

thickened and covered by shreddy bands of adventitious organised
fibrous tissue. The splenic parenchyma is throughout much
condensed and the trabeculae thickened. Towards the centre,
however, of each organ a honeycombed appearance is presented,
owing to a washing away of the pulp substance during long
maceration in spirit.

16. A large, tabulated, firm spleen, with a “ spleniculus ” or accessory

spleen attached by a fold of thickened peritoneum to its hilum,
near the upper extremity. The former exhibits great thicken-
ing and dark-brownish discoloration of the capsule, a firm
condensed condition of the parenchyma, with prominence of
the Malpighian bodies, and general pigmentation. At the lower
extremity a deep depression or furrow is seen, passing nearly
^ through the entire thickness of the organ here, and almost
separating a portion of the same to form another spleniculus.
(Presented by Mr. D. Picachy, of Hooghly.)

17. Enormous hypertrophy of the spleen, the organ weighing 51b

2 ozs. “ From a Hindu adult (Ramdial), who had been suffering
for a tang time from intermittent fever, and died in hospital.”

18. Greatly hypertrophied spleen, from a native woman, aged 35, who

had suffered from malarial fever more or less continuously for
twelve months previous to her admission into hospital. She
was admitted with ascites, and paracentesis was performed twice,
at intervals, giving temporary relief ; a third operation was follow-
ed by acute general peritonitis, to which she succumbed. The
capsule of the organ is greatly thickened — quite leathery in
parts. The splenic parenchyma is firm, dark-red, shows much
thickening of the trabecular structure, irregular pigmentation,
and all the other characters of a chronic “ ague-cake.”

19. Leukaemic hypertrophy of the spleen. The organ is enlarged to

about three times its normal size. The capsule is throughout
much thickened and opaque. The surface is rough and tuber-
culated from the projection of numerous opaque-white, firm,
nodular growths. They are also well seen on section, and
consist of the Malpighian bodies of the organ in a state of hyper-
plastic development. These bodies vary in size from a mustard-
seed to a pea, are firm, more or less homogeneous, and occupy
almost the whole of the pulp-spaces in the substance of the organ.
They can be picked out readily with the needle, and when
transferred to the stage of the microscope, exhibit a purely
adenoid structure, consisting of lymphoid corpuscles thickly
aggregated, and possessing a scanty, small-meshed stroma.

ihe fibrous trabeculae throughout the spleen are much thickened, and
where the hypertrophied Malpighian bodies have fallen out
during maceration, a honeycombed appearance is presented by
the cut surface of the organ. The pulp-substance lias in great
part disappeared, compressed and dispersed by the overgrowth

368

ATROPHY OF THE SPLEEN.

[series X.

of the Malpighian bodies.* No reaction is obtained with solution
of iodine. No history. (Presented by Dr. F. Oxley, of Singa-
pore.)

20. A less well-marked example of leuksemic spleen. Organ heavy,
compact, enlarged to about twice the normal size. Capsule
rough, opaque, and coarsely granular, or slightly tuberculated.
On section, trabeculae hypertrophied ; Malpighian bodies stand
out prominently, are about the size of millet-seeds, firm, homoge-
neous, and seen under the microscope to be composed of simple
adenoid tissue. No iodine reaction. ( Presented by Professor
Edward Goodeve.)

21. A small, atrophied, and pigmented spleen, from a case of acute

dysentery.

22. An atrophied spleen, from an aged native (aged 60 years), “ who

died in the Howrah Hospital after an accident.” (Presented by
Assistant-Surgeon Gopal Chunder Roy, Howrah.)

23. Small, contracted, and atrophied spleen. The capsule is opaque and

thick. The substance somewhat dark, but otherwise healthy.
The weight 2i ounces. — From a native woman aged 33, who died
of chronic dysentery.

24. An atrophied spleen, weighing only two ounces. From a case of

chronic dysentery, — a native male, aged 25, who died in hospital.

25. A very small, atrophied spleen, weighing only an ounce and a half.

From a native woman, aged about 80, “who was run over by a
buggy and died seven hours after the accident from rupture of
the liver and fracture of twenty-one ribs.” (Presented by the
Police-Surgeon.)

26. Atrophied spleen, weighing not quite half an jounce. From a

European (male), aged 68, who died of chronic dysentery.

27. “ An enlarged spleen with localized thickening of the capsule.

The altered capsule is fully three-quarters of an inch in thickness
and about three inches in its longest diameter. On one side,
facing the hilum, its extension is abruptly limited ; but on the
other side its edges taper off, and the section shows that this
gradual diminution of thickness extends some distance into the
capsule. The altered capsule consists of an external and internal
dense and hard lamina of coarse fibrous tissue, enclosing a thick
deposit of recently-organized lymph.” (Ewart.)

28. A spleen showing dense fibroid thickening of the capsule over

the upper third of the convex surface. It is here nearly a
quarter of an inch in thickness, has the appearance of, and cuts
like, cartilage. The thickening is, however, quite homoeplastic,
consisting of white and yellow fibrous tissue only.

29. “ A small spleen, from which a part of the capsular investment

has been carefully removed to show its thickness, which uniform-
ly measures almost a quarter of an inch. It is as hard, firm,
and unyielding as cartilage.” (Ewart.)

30. The spleen of a native patient who died from pneumonia. The
surface of the organ is studded with small, button-like, opaque-

• This is well seen in thin sections placed under a low power.

SERIES X.]

ABSCESS OF THE SPLEEN.

300

white and waxy-looking, flattened projections. These are com-
posed of condensed fibrous tissue, and the_ result of clnonie
inflammatory thickening of the splenic capsule.

31. A similar specimen, the capsul ar thickening, however, being

confined principally to the lower third ol the organ, where it is
of cartilaginous appearance and density. — From a Mahomedan

patient, aged 50. . .

32. “ A spleen, normal in dimensions, but containing at one point

tissue undergoing disintegration from suppurative inflammation.
A portion of the pulp underneath the capsule is broken down,
and there is a deposit of lymph over this situation.” (Ewart.)

( Presented by Professor Allan Webb.)

33. “ Abscess of the spleen. At each extremity of the organ there

is an excavation the size of a pigeon’s egg, the sites of abscesses,
over which the splenic parenchyma, capsule, and peritoneum are
completely destroyed. The parieties ol the cavities are irregular,
with flocculent shreds hanging from them.. The organ is
moderately enlarged, and the capsule slightly thickened from the
organization of lymph.” (Ewart.) ( Presented by Dr.
Chuckerbutty.)

34. A large abscess at the upper end of the spleen. The organ, itself

is enlarged. The abscess is the size of an orange. The thicken-
ed capsule alone forms its anterior boundary or wall. This was
accidentally torn during removal post mortem. The whole
organ is enlarged, dark, and soft. There had been no symptoms
indicating the existence of this lesion during life. The patient,
a native female, aged 30, died from rheumatic fever compli-
cated with recent valvular endocarditis. ( See prep. No. 132,
Series VI.)

35. Spleen greatly enlarged, and showing a circumscribed abscess-

cavity the size of a small orange at its superior extremity.
The walls of this cavity are superficially sloughy, and were
adherent to the diaphragm. The latter was found similarly
softened, sloughy, and perforated, — an opening about the size of
a rupee. The base of the left lung, partially adherent over this
spot, was carnified ; the left pleura acutely inflamed, and its
cavity completely filled with sero-sanguineous fluid. — From a
native lad, aged 15, who died in hospital.

36. Abscess of the spleen, the size of a turkey’s egg, situated at

the superior extremity of the organ. The abscess-cavity has a
well defined outline, its walls are thick, dark, and sloughy, but
exhibit the remains of a well formed lining or pyogenic
membrane. It contained nearly four ounces of thin, reddish pus,
and, at its centre, a slough of the splenic substance about the
size of a walnut.

The organ is enlarged to about twice its normal size (weighing
Ilf ozs.), and is throughout dark and soft. From a European
(male), aged 43.

37. A very large abscess of the spleen, occupying the upper half of

the oraran. which is itself increased to about four times its
normal size. The walls of the abscess-cavity are soft, thinned,

370

CIRRHOSIS OF THE SPLEEN.

[series X.

and shreddy. This abscess communicated, by perforating the
diaphragm, with the left pleural cavity, into which it ruptured,
producing death suddenly. On 'post-mortem examination the
left pleural sac contained nearly two pints of pus and a large
blood-clot, the latter projecting into it from the disorganised
spleen. In the preparation it may he seen filling a portion of
the large cavity which has been hollowed out of the substance
of this organ.

I rom a native female, aged 35, who had been suffering for a long time
from intermittent fever and dysentery. “ Three small abscesses
were found in the left kidney.”

38. “ An atrophied spleen taken from an aged dropsical patient. It
is about two inches and a half long and scarcely an inch in
thickness. The notch is half an inch in depth. There are two
rudimentary fissures on its convex border. The capsule is
slightly wrinkled from shrinking of the parenchyma, and there
are a few opaque spots upon it.” (Ewart.) The surface is
roughened and coarsely granular, presenting a cirrhotic appear-
ance.

39. Cirrhosis of the spleen. The capsule of the organ is of dark

greyish-yellow colour, and much thickened. The splenic sub-
stance is intersected in all directions by fibrous bands (thickened
trabeculse) continuous with the capsule at the periphery. In
parts this fibroid tissue is rendered still denser, and has a “ gritty ”
feel from the presence of minute calcareous particles. The
proper pulp-structure is much atrophied and compressed. The
surface of the spleen is uneven and tuberculated. From a
patient who died from dysentery. “ The liver was incipiently
cirrhotic.” ( Presented by Professor Chuckerbutty.)

40. A contracted and cirrhotic spleen. The capsule is rough,
opaque, and much thickened. The substance firm, tough,
anaemic, of a greyish-red colour, and the trabecular or fibrous
structure throughout hypertrophied. The surface of the organ
is rough, irregular,— almost nodulated.

The liver was markedly cirrhotic. — From a native male, aged 50, who
died in hospital. (“ Medical Post-viortem Records,” vol. II, 1878,
pp. 747-48.)

41. A small, wedge-shaped “ block ” or haemorrhagic infarction of
the spleen, rather larger than a pea, and situated just beneath
the capsule, at the periphery of the organ, near its lower or
inferior extremity. It is undergoing decolourisation.

42. Spleen with two large decolourising “haemorrhagic infarctions”

situated near the upper and lower extremities of the anterior
notched margin of the organ. The spleen is large, dark, and
pigmented.

From an Armenian (male) patient, aged 20, who died from valvular endo-
carditis, &c.

Similar infarctions were found in the pancreas and right kidney.

43. Spleen showing at its lower extremity a kind of globular appendix,

connected to the rest of the organ by a constricted portion or
neck. This globular body, on section, is seen to be composed

SEKIE8 X.]

INFARCTIONS OF THE SPLEEN.

371

chiefly of a bloody extravasation, which has become imperfectly
encysted. It looks quite like an ordinary haemorrhagic infarct,
but may perhaps have been the result of some recent injury.
The specimen was taken from a Negro, aged 35, who died in
hospital of cholera.

44. Spleen exhibiting numerous small, wedge-shaped, distinctly cir-
cumscribed “ blocks ” or infarctions of a dark-purple colour,
thickly distributed at the periphery of the organ, just beneath
the capsule, and a few more deeply imbedded in its substance.
— From a native male, aged 28, who died of cholera.

45. A portion of a spleen which weighed 4 pounds 11 ounces. The

capsule is thick and opaque ; the substance dark and irregularly
pigmented. At the upper and outer part of the superior end of
the organ is a large “ block ” or haemorrhagic infarction, dis-
tinctly wedge-shaped, of pinkish-yellow colour on section, about
two inches square at the surface, beneath the capsule, and reach-
ing from half an inch to an inch into the substance of the organ.
It is surrounded by a dark hyperaemie zone of congested vessels.
— From a native male, aged 21, who died of remittent fever and
dysentery.

46. Spleen with one large and several smaller “ haemorrhagic infarc-

tions,” occupying the peripheral portion of the parenchyma, just
beneath the capsule, which is slightly elevated by them. In the
fresh state these presented a pale-yellowish or buff colour— i.e.,
were undergoing decolourisation. — From an East Indian, aged
27, who died from pyaemia after the operation of forcible
dilatation of the urethra (by Plolt’s method) for stricture.

lluth kidneys presented numerous blood extravasations and points of
incipient suppuration. ( See prep. No. 55, Series XI.)

47. Pyaemic lesions of the spleen. The organ is much enlarged. Its

capsule is thickened, was adherent to the diaphragm, and over
its upper half highly injected and inflamed. On section here an
“ infarction,” rather larger than a walnut, may be seen, extending
from just below the capsule into the splenic pulp, and occupying
the whole thickness of the superior extremity of the organ. The
greater portion of this “ block ” is in a state of yellowish cheesy-
like transformation, but a portion of it, towards the hilum, is
softened and purulent, and, more deeply . seated around this
infarction, are several small pea-like abscesses. (Weight of spleen
lOi ounces.)

From a native male, aged 34, who died from osteomyelitis and pyaemia
after amputation of the arm for gangrene following compound
fracture of the humerus. ( See further, “ Surgical Post-mortem
Records,” vol. I, 1877, pages 403-404.)

18. Typical amyloid or “ sago ” spleen, from a girl, aged 18, who died
from dysentery complicating renal dropsy. The organ is
enlarged to more than twice its normal size ; is very firm and
hard. On section anaemic, and freely infiltrated with brownish,
glistening, wax-like material, — the altered and hypertrophied
Maipighian bodies. A characteristic reddish-brown reaction is

AMYLOID DEGENERATION OF THE SPLEEN, [series x.

given with solution of iodine. The kidneys were similarly affect-
ed. ( See prep. No. 59, Series XI.)

Thin sections from the above spleen, exhibiting to perfection the
abnormal condition of the splenic pulp, due to the presence of
the infiltration. The greatly enlarged Malpighian bodies closely
resemble boiled and swollen sago-grains.

Amyloid degeneration of the spleen. The organ is enlarged
to about three times its normal size. The capsule is

tense, stretched, irregularly thickened, and opaque. The sub-
stance is firm, pale reddish-brown ; in the fresh state
presented a peculiar glistening waxy appearance, which has been
somewhat lost after preservation in spirit. The changes both
physically and microscopically are characteristic of albuminoid or
“ waxy ” infiltration, affecting chiefly the Malpighian bodies and
the smaller arteries, the pulp-substance still remaining com-
paratively free. A distinct reddish-brown reaction is given with
iodine. — From an East Indian (male), who died from chronic
dysentery, and had also commencing pulmonary phthisis.

Similar changes were observed in the liver, kidneys, intestine, &c.

51. A myloid or albuminoid infiltration of the spleen. The organ is

enlarged to about four times its normal size. The capsule is
stretched, opaque, and thickened, shows dark-brownish dis-
colouration in patches. The borders are rounded and smooth.
The splenic substance is firm, anasmic ; had a glistening waxv-
looking appearance when fresh. The Malpighian bodies are
chiefly affected, are enlarged and swollen. A characteristic
reaction is given with iodine.

The patient, a native male, aged 30, was admitted into hospital very
low, anaemic, and with general anasarca. The urine contained
albumen. There was fever and bronchitis. The latter passed
into pneumonia, of which he died on the eleventh day.

Similar (amyloid) changes were found in the kidneys and small
intestine.

52. Amyloid (“sago”) spleen. The organ is greatly enlarged; its

borders rounded ; consistency firm. The capsule is opaque and
thickened. On section numerous rounded semi-translucent bodies
are seen thickly infiltrating the whole splenic pulp-substance.
These are about the size, colour, and consistency of boiled sago-
grains, and, when treated with solution of iodine, give a charac-
teristic reddish-brown reaction.

Similar (amyloid) changes were found in the ileum ; and both kidneys
were also slightly affected.

From a European (male) patient, aged about 40, who died from hepatic
abscess, &e.

53. Amyloid spleen, weighing 9 ounces. — From a European seaman,

aged 37, who died of acute uraemia from Bright’s disease. The
kidneys were large, pale (tubular nephritis), and slightly amy-
loid. There was also amyloid infiltration of the liver.

Examined microscopically, the degenerative change in the spleen is seen to affect
(1) the minute arteries of the organ, and (2) the Malpighian bodies. It
does not extend into the pulp -substance, and is therefore, presumably, in the

372

49.

50.

semes x.] PIGMENTATION OF THE SPLEEN.

373

early or less advanced stage of the disease. The walls of the arteries are
lustrous and swollen; the Malpighian bodies enlarged and of the appearance
of small boiled sago-grains. Both give a very distinct reaction with iodine
solution. (See further, “ Medical Post-mortem Records,” vol. II, 1876,

pp. 281-82.)

54. Spleen of about normal size and weight, but incipiently amyloid.

The substance generally is firm, and of a pale reddish-brown
colour. Here and there points or granules of a semi-transparent
glistening character are seen, about the size of mustard-seed.
These are the enlarged and infiltrated Malpighian bodies, and
give a distinct reddish-brown reaction with solution of iodine.
The liver and kidneys also showed amyloid changes. — From an
American seaman, aged 45 years, who died in hospital of pul-
monary phthisis. (Medical Post-mortem Records,” vol. II,
1878, pp. 729-30.)

55. The spleen of a native child, aged about eight years, who died

from chronic dysentery with much malarial anaemia. The organ
is enlarged ; the capsule slightly opaque and thickened ; the
substance dark, somewhat soft ; the Malpighian bodies remarkably
large, opaque-white, and prominent. Under the microscope, the
lymphoid structure of the latter is seen well developed, and
apparently excessive even for early life ; the surrounding pulp-
substance is atrophied and pigmented, and a very large quantity
of dark, granular pigment is found deposited in the fibrous tissue
of the trabecular structure, which is throughout hypertrophied.

56. A large and darkly-pigmented spleen, showing also much fibroid

thickening of the capsule. From a native male patient, who had
long suffered from intermittent fever and “ spleen disease,” and
who died in hospital. *

57. An enlarged and darkly-pigmented spleen. At one extremity

there is a circumscribed oval-shaped thickening of the capsule,
about the size of the palm of the hand, and from one-fourth to
one-third of an inch in thickness. It has a laminated fibrous
structure, and appears to be the result of localised inflammatory
changes in the splenic capsule. The weight of the organ is 14
ounces. From a native male, aged 30, who died of dysentery.
(Presented ly Dr, Edward Bovill, General Hospital, Calcutta.)

58. A large, darkly-pigmented spleen (malarial), exhibiting also much

hypertrophy of the Malpighian bodies and trabecular structure.
— From a native male patient, aged 1G.

59. A soft, swollen, very darkly pigmented spleen (malarial). — From

a native male, aged 24, who died from dysentery, with a history
of having suffered, for twenty-one days previously, from intermit-
tent fever. He was brought to the hospital in a moribund
condition. In this case the liver and brain (grey matter)
also showed an unusually dark appearance.

60. A large, soft, and darkly-pigmented spleen. — From a case of
malarial melanamiia — a native lad, aged about 14, who died in
hospital. The liver and brain showed similar pigmentary
changes, and the blood removed from the heart post mortem and
examined microscopically revealed the presence of much dark

374-

TUBERCLE OF THE SPLEEN.

[series X.

pigmentary matter, free or contained within leucocytes. Weight
of the spleen 10|- ounces. ( See also prep. No. 317, Series IX, and
“Medical Post-mortem Records,” vol. II, 1878, pp. 679-80).

61. Spleen dark and pigmented, with also three or four small “ in-

farctions ” undergoing decolourisation. — From a native boy,
aged 12, who died from malarial anaemia and exhaustion. The
liver was similarly affected. ( See prep. No. 319, Series IX.)

In the spleen the pigmentation is most profuse; the colouring-matter very dark,
granular or amorphous; free, and also deposited within the cells of the
pulp-substance, and infiltrating small round cells, probably leucocytes.
The splenic structure is much disorganised ; — in parts no trace even of the
same can be seen, — nothing but a confused mass of red and white blood
corpuscles, tailed and filiform epithelium, and dark pigment granules.

62. “ A portion of the spleen of a native female in which a circum-

scribed mass of strumous deposit was found in the parenchyma.”
At the surface of the organ, at the spot where a section exposes
this deposit, a group of tubercles underneath the capsule are
observed. “ Both lungs were found crammed with tubercles.”
(Ewart.)

63. Spleen studded over with tubercular deposit, confined chiefly to

the capsule. From a case of general tuberculosis. “ Rifleman
Lalloo Guram, 2nd (Sirmoor) Gurkha Regiment, Native
Infantry.” The lungs, peritoneum, pancreas, and mesentery were
all found similarly affected. ( Presented by Surgeon R. T. Lyons,
20th P. N. I., Rawul Pindi.)

6 1. Spleen enlarged and softened, and exhibiting a large number of
tubercular granules and small nodules at the periphery, situated
mostly just beneath the?- capsule. — From a case of general
tuberculosis, — an Australian, James B., aged 30. The liver
was similarly affected, and the mesenteric glands enormously
enlarged and cheesy. ( Presented by Professor Chuckerbertty.)

65. Spleen diffusely and thickly infiltrated with miliary granulations

(tubercle.) These are either pale-grey or yellowish, and about
the size of small sago-grains. — From a native male, Sobrati,
a(red 30, who died from acute general tuberculosis. (“ Medical
Post-mortem Records,” vol. Ill, 1879, pp. 343-44.)

66. A section from the lower half of an enlarged spleen, showing two

cretaceous chalky deposits. The larger is the size of a nutmeg,
and somewhat deeply situated ; the smaller, nearer the surface,
and at the lower extremity of the organ, is the size of a pea.
Both are surrounded by condensed fibroid tissue.— From a
native male, aged 35, who died from acute peritonitis following
an operation for strangulated inguinal hernia.

67 Spleen a little enlarged and infiltrated with soft, yellowish-
white nodules, consisting of adenoid or lymphoid tissue.
The liver, kidneys, mesentery, &c., were all found similarly
affected (Hodgkin’s disease, or lymphadenoma.) The patient,
a native female, aged 40, was admitted into hospital sullering
from anaemia, and had a slight leucorrhceal discharge. She died,
apparently of exhaustion, on the tenth day. The morbid

sKBiEs x.] SANGUINEOUS CYST OF THE- SPLEEN.

375

growths were not suspected during life — only discovered post
mortem. (See also prep. No. 330, Scries IX.)

168. Hodgkin’s disease, or lymphadenoma. The spleen of an East
Indian woman, aged 25, who was brought to the hospital in a
moribund condition.

The organ is enlarged, its capsule thickened, and substance infiltrated
with opaque-white, slightly waxy-looking growths, varying in size
from a small hazelnut to a pea ; a few smaller.

69.

JExamined microscopically, these are found to be composed of cells about the size of
white blood corpuscles, imbedded in a delicate, small-meshed reticulum
of connective tissue — evidently, therefore, lymphomatous in structure.

'The whole of the peritoneum, great omentum, mesentery, &c., were
infiltrated with similar granules and small nodules, or exhibited
thickened patches, having an identical structure. ( See further
“ Medical Post-mortem Kecords,” vol. I, 1875, pp. 517-18.)

A spleen with a large cyst, occupying the whole of the lower
two-thirds of its outer surface. “ When the cyst was cut into
about twenty-eight ounces of dark-brown fluid escaped. The
outer walls of the cyst were adherent to the diaphragm and
adjacent parts.” The spleen is enlarged, very soft, and spongy.
The cyst-like formation consists of the thinned and expanded
portion of the capsule of the organ which normally invested the
lower two-thirds of its outer surface. A large cavity, containing
the fluid above described, seems to have formed between the
capsule and splenic parenchyma. Stretching between these parts
(as viewed from the interior) are delicate bands of newly-formed
connective tissue, and minute capillary vessels, while a semi-
stratified layer of coagulated blood, varying from two to four
lines in thickness, is met with immediately in contact with the
latter (splenic substance.) The pseudo-cyst seems, therefore, to
have been produced by a considerable blood extravasation
(perhaps from injury), at the surface of the spleen, collecting just
beneath the capsule, and detaching the latter over a limited space.
From some cause inflammation has succeeded the extravasation
Partial organisation of the effused material has taken place
and, at the same time, a portion of the blood has formed a’
stratified deposit, the remaining fluid portion being evacuated
by the opening made into the cyst-wall (stretched capsule)
at . the post-mortem examination. The dark colour of the
fluid which then “ escaped” seems to confirm the view taken of
the mode of formation of this very rare lesion — i.e., from blood
extravasation. — From a native prisoner (male) who died in the
Presidency Jail from diarrhoea. ( Presented by Dr. C. H. Joubert
Calcutta.) ’

“A spleen enlarged to twice its normal bulk, having four fissures on
its anterior margin, varying from a half to two inches in depth
Ihere is another fissure on the posterior margin upwards of three
^and a half inches in length.” (Ewart.)

“ A spleen having three small fissures in its anterior margin and
a similar number in its posterior convex border, with two on its

376

DISEASES OF THE THYIIOID GLAND. [seeies x.

inferior surface, where there is a ‘button-shaped supplementary
spleen.” (Ewart.)

72. A congenitally multilohulated spleen. It consists of seven distinct
and separate lobules or nodules of irregular shape and size, all
bound together by loose connective tissue and peritoneum. It
weighs 6ii masse J5| ounces.

From a native female, aged 18, who died from a malignant tumour
(sarcoma) of the back.

There was also congenital malformation of the heart in this case. ( See
further, “Medical Post-mortem Eecords,” vol. Ill, 1879, pp.

3S4-85.) . ,

73 An accessory spleen or spleniculus, of globular shape, and the
size of a nutmeg, attached by a fold of thickened peritoneum to
the lower end of the hilum of a chronically hypertrophied spleen.

{ Presented by Assistant Surgeon Tameez Khan.)

74. A spleniculus or accessory spleen, weighing an ounce and a half,

found on 'post-mortem examination of the body of a young Hindu
girl aged 18, who died from anaemia and exhaustion conse-
quent upon a long continuance of chronic intermittent fever with
splenic hypertrophy. The spleen itself was very large, daik, and
soft. It weighed 21b 7ozs.

This accessory organ was attached by a fold of peritoneum to the hilum
of the spleen proper, at about its centre. _ # j

75. Two small accessory spleens (spleniculi), one, the size of a pigeon s

ego-, the other, of a nutmeg, found near the hilum of the spleen
proper, and connected with the same by means of a fold of
peritoneum thickly infiltrated with fat.

The subject was a Chinese (male), aged 35, who died of chronic

dysentery. f ,

76. Spleen of the Ourang-Utan, containing several masses of tuber-

cular deposit.” (Allan Webbj Pcitholoyici Indica , No. 31—, p-
143.) (Presented by Dr. F. Oxley of Singapore.)

77 “ Larynx and trachea, with enlargement of the thyroid body.

Each lateral lobe is elongated to about three inches, and
encroaches upon the oesophagus to a slight extent. These are
joined in front by two nodular enlargements slightly constricted
in the mesial line by a firm and strong band of fibrous tissue.
A transverse section of the left lateral lobe shows that the
growth consists of cysts with laminated walls, containing solid

contents.” (Ewart.) . , . . ,

78 “ Larynx and upper part of the trachea and hypertrophied thy i

body. The two lateral lobes are as large as hen’s eggs, connected
by the central lobe, almost the size of a pigeon s egg, from
which a process is given off,” which, ascending upwards, is united
to the hyoid bone by a short band of fibrous tissue.

79 Hypertrophied right lobe of the thyroid gland from a native

female, aged 50. It is seen, on section, to be highly cystic-
The cysts vary in size from a pea to a hazelnut, and are occupied
by brownish, gelatinous-looking material (colloid). Then
are thick and fibrous, and in parts calcified ; as also are portions

of the capsule of the gland.

SERIES X.]

BRONCHOCELE (GOITRE;.

377

80. Fibroid hypertrophy of the thyroid gland. Both lobes and the
isthmus are enlarged ; — each of the former to the size of a small
orange, the latter is as large as a nutmeg. On section chiefly
fibroid thickening of the gland-parenchyma is found, interspersed
with cysts of varying calibre, but mostly small, and filled with
mucoid or sanguineous fluid. The cartilaginous portion of the
upper half of the trachea is embraced by the hypertrophied
thyroid body. — Taken from a native woman, aged 50, who died
of cholera.

81. “ Larynx, portion of the trachea and oesophagus, and enlarged

thyroid gland of an old woman. The walls of the small cysts,
of which it is mainly constituted, are hard and cartilaginous in
consistency. The lateral lobes are about four inches long and
an inch and a half in thickness. The central lobe is propor-
tionately enlarged.” (Ewart.)

On microscopical examination, there is found general hypertrophy of the proper
structure of the gland, together with mucoid or colloid advancing degener-
ation. The natural loculi are expanded, and, by atrophy of the intervening
fibrous septa, and coalescence of two or more such spaces, cyst-like cavities
are formed, thickly crowded with granular, pigmented cells j or, the latter
gradually disappearing, their place is occupied by soft, flickering, colloid or
mucoid material. In parts the septa, instead of being atrophied, show con-
siderable thickening and opacity, with sparing calcareous infiltration. —
J. F. P. McC.

82. “A serous cyst in the thyroid body, the contents of which had

undergone purulent degeneration. The cavity measures an inch
in its longest, and three-quarters of an inch in its shortest,
diameter. The cyst is centrically situated. The internal sur-
face of its wall is tolerably smooth in some parts, and more or
less puckered and irregular in others.” (Ewart.)

83. A very large thyroid tumour (bronchocele), involving both lobes

and isthmus of the gland, and forming a dumb-bell-shaped mass,
placed transversely across the trachea, embracing it, the pharynx,
and oesophagus, and almost completely filling the space between
the chin and the episternal notch. The right lobe is more
developed than the left. The structure is that usual to such
growths, — a cystic dilatation of the normal ampullae or lobules of
the gland, which are filled with mucoid or colloid material for
the most part, but, in certain situations, show (under the
microscope) cheesy, granular, fatty contents, and in others,
blood ; the latter recognised by the presence of deep-yellow
coloured pigment and fragmentary corpuscles. The pseudo-
cysts vary much in size ; some are quite microscopic, others
readily recognised by the unaided eye (as seen in the section
which has been made through the right lobe). The fibrous
septa, ^ connecting these together, exhibit in parts mucoid or
fatty infiltration, in others are hard, rigid, and calcified. A capsule
of fibrous tissue, thus partially calcified, surrounds or invests the
entire growth.— From a native female who died in hospital.

84. A specimen of hypertrophy of the thyroid gland (bronchocele)

which proved fatal by inducing sudden spasm of the glottis,

378

DISEASES OF SUPRA-RENAL BODIES.

[series X.

owing to pressure on the recurrent laryngeal nerves. There
was no oedema of the glottis, or any other morbid condition
of the interior of the larynx. The lateral lobes of the
gland form two large kidney-shaped growths on either side
of the larynx and trachea, the left being the larger. The
isthmus is also hypertrophied, measures about 1" x Be-
tween these structures the windpipe, from the thyroid carti-
lage to within two inches of the bifurcation of the trachea, is
tightly embraced. The outline of the bronchocele is much
lobulated ; on section, it is highly vascular, and presents a kind
of minutely honeycombed appearance, produced by a series of
small cells or cyst-spaces, occupied by a soft, flickering, jelly-
like material. These constitute smaller and larger lobules,
separated by bands of fibrous-looking tissue.

Microscopic examination confirms the condition of structure above described.

Larger and smaller mucoid spaces or spheres are found, having at their
margins large, nucleated, granular cells, but the rest of the sphere filled
with jelly-like rippled material, with only here and there the remains
of degenerate stellate and round cells. These spheres or spaces are separated
by delicate connective tissue, supporting blood vessels of considerable size.

History. Miss A. S. , aged 18, was admitted into the General Hospital

with this growth in the neck, and stated that it had existed for six months.
Was small at first, but has gradually increased to present size. “It was
soft to the feel, but no bruit could be heard in it. It compressed the
trachea, and the breathing was accompanied with a peculiar whistling
sound. The patient was subject to paroxysmal attacks of dyspnoea. On
the morning of the fourth day after admission, during one of these sudden
attacks, she died. There was no difficulty whatever in swallowing. No
abnormal cardiac murmurs, &c.. Death was caused from spasm of the
glottis, due to pressure' on the recurrent laryngeal nerves by
the tumour.''1 ( Presented, by Dr. F. C. Nicholson, General Hospital,
Calcutta.)

85. The supra-renal bodies from a native male patient who died of

pneumonia. The left gland is hypertrophied, and its capsule
here and there marked by small, milk-white spots of thickening.
The right is healthy. There was no cutaneous discolouration
or any other indication of “ Morbus Addisonii.”

86. Supra-renal glands from a case of suspected Morbus Addisonii, an

East Indian woman, aged 59, who died in hospital of chronic
dysentery.

Both organs are somewhat small, the right flattened, the left puckered
and contracted. Their capsules are opaque and thickened. On
section the proper gland-structure appears to be atrophied. No
morbid growth or deposit is observed. Each supra-renal body
weighs one drachm.

Examined microscopically, sections (both longitudinal and transverse) from these
bodies show (1) thickening of the fibro-cellylar capsule, chiefly by
homologous, well-formed connective or fibrous tissue, but, in parts, by a
nuclear proliferation, which, however, is only found in some of the sections,
is quite absent in others. (2) The proper gland-structure, both cortical
and medullary, exhibits no new growth or infiltration; the vertically placed
columns of the former present the usual yellowish-coloured epithelial cells
with large single nuclei, only much infiltrated with fat; and a good deal

SERIES X.]

DISEASES OF LYMPH-GLANDS.

379

of free fit (in globules and molecules) lies between the columns, in the
fibrous dissepiments which divide them. In parts this proper gland-tissue
has quite broken down, spaces being found occupied by a molecular fatty
debris only, the result evidently of disintegration of the epithelial elements.
(3) Almost similar changes are detected in the medullary portion. There
is no new or specific growth ; no amyloid or caseous, degeneration. The
morbid conditions discovered consist of fibroid thickening of the capsules
of these glands, puckering and contraction of the latter (especially of the
left), combined with fatty infiltration and atrophy. ( See further, “ Medical
Post-mortem Records,” vol. II, 1876, pp. HG3-64.)

87. Cancerous (melanotic) infiltration of the supra-renal bodies. The

deposits are isolated, and well defined, appear to affect only the
fibrous capsules of these organs, the proper gland-structure
remain i n g un implicated .

From a case of general melanosis, an East Indian male, aged 44. The
brain, lungs, liver, bones, &c., were all similarly affected. (See
preps. Nos. 45, Series VIII ; 342, Series IX, &c.)

The structure of the deposits is that of true enkephaloid carcinoma, only
modified by dark, granular, pigmentary infiltration of both
stroma and cells. (“ Medical Post-mortem Records,” vol. I, 1873,
p. 10.)

88. Tubercle of the lymph glands. The specimen shows a group of
enlarged inguinal glands, the largest about the size of a duck’s
egg, — taken from a case of general tuberculosis,— an East
Indian (male,) aged 35.

On section the glands are seen to be diffusely infiltrated with yellowish-
white tuberculous deposit, most marked in the peripheral or
cortical portions. In parts it forms small caseous nodules, and
in others shows incipient softening. Besides these glands, the
mesenteric glands, the liver, spleen, kidneys, and lungs, were
thickly infiltrated with tubercular granules.

89. Strumous enlargement of the deep cervical glands. The prepara-
tion shows a chain of these, from the right side of the neck, all of
which are more or less indurated, cheesy, and of a pale-
yellowish colour on section. The corresponding glands on the
left side of the neck had ulcerated.

The lymph glands in the anterior mediastinum were also enlarged and
caseous.

There was a family history of scrofula. The patient, a West
Indian (male), aged 22, a seaman, died from acute general
tuberculosis. (See further, “ Surgical Post-mortem Records,”
vol. I, 1875, pp. 191-92.)

90. A group of enlarged lymph glands from the anterior mediastinum
in a case of lymphadenoma (Hodgkin’s disease). The largest,
the size of a walnut, was situated just above the arch of the
aorta, a little to the left of the median l'\ne. They are ail soft
in consistency, milky-white in colour, or partially cheesy (as seen
on section), matted together by the thickened and infiltrated
cellular and connective tissue of the mediastinum and surround-
ing parts (pleura, pericardium &c.). The structure of this
infiltrating material is purely lymphomatous, and has spread,
by direct continuity of tissue, from the glands to the adjacent

380 CANCER OF LYMPH-GLANDS. [sebies x.

parts. Both pleurae, the lungs, the diaphragm, &c., were
all similarly affected. — From a native female aged 25. ( See
further, “Medical Post-mortem Records,” vol. 1, 1875, pp. 517-18.)

91. A cancerous tumour, the size of an orange, removed from the

arm. It is lobulated in outline, pretty firm on section, and is
then seen to be mapped out into alveolar-like spaces by white
fibrous tissue, the centres of the spaces being occupied by softer
brownish material. At the centre of the tumour its substance
is especially soft, and partially cheesy. Microscopically, the
structure is partly adenoid, — consisting of small, round, nucleated
cells in a fine-meshed stroma, is partly composed of large
collections of rounded epithelial cells with distinct nuclei ; and
the transformation of the lymphoid into epithelioid (can-
cerous) cells can be traced quite readily in some of the sections
made. There is no history, but, apparently, this is a large
secondary cancerous growth affecting certain of the subcu-
taneous lymphatic glands of the arm.

92. “ Section of brain-like cancer of the inguinal glands. The growth

had begun to fungate through the skin of the groin, as demon-
strated in the preparation.” (Ewart) This is a broadly lobu-
lated growth, the size of one’s fist. The gradual transformation
of the lymphoid tissue (adenoid cells) into larger epithelial-
looking cells, with the thickening of the intercellular fibrous
tissue into stroma, is very distinctly exhibited in sections placed
under the microscope.

93. Portions of a morbid growth (colloid carcinoma) found infiltrating

the post-peritoneal connective tissue and lymphatic glands of the
abdomen, surrounding the aorta and vena cava, and following the
course of their branches (iliac and femoral) to the brim of the
pelvis, and thence, beneath Poupart’s ligament, into the thighs.
In the last situations the inguinal glands were also much enlarged
and morbidly infiltrated.

Sections of this growth, examined under the microscope, reveal the structure of true
colloid cancer. Polymorphous epithelial -like cells with distinct single or
multiple nuclei are found in large numbers, imbedded in the meshes of a
very delicate, soft, connective-tissue stroma. In other parts, chiefly jelly-
like colloid material fills these spaces, the cells being very few in number,
granular, and broken down. A colloid infiltration of the cells themselves
is not very distinctly seen, but a large amount of this material infiltrates
the whole structure of the new growth. Further, much fatty or adipose
tissue surrounds the lobulated masses, and, along the connective tissue
dissepiments of the same, numbers of small, round, growing cells are observed,
clearly indicating an extension, by infiltration, to the surrounding structures.
In the portions removed from each groin, the normal gland (lymphoid)
elements of the part are largely combined with the new growth, and are
seen to be in active proliferation.

From a European female, aged 65, who died in hospital. (“ Medical
Post-mortem Records,” vol. I, 1875, pp. 939-40.)

94. The lumbar and post-peritoneal lymphatic glands of the abdomen,

showing extensive infiltration with soft cancer. Some of the
former are enlarged to the size of a potato, and exhibit, under
the microscope, an active or rapid proliferation of the proper

SEBIES X.]

SAECOMA OF LYMPH-GLANDS.

381

lymphoid or adenoid structure, with cotemporaneous form-
ation of spaces, in which a soft mucoid-looking stroma with
epithelial elements imbedded in it are to be found.

The lungs and liver were similarly affected. — From a case of primary
enkephaloid carcinoma of the testicle, a European patient,
aged 43.

95. An enlarged and infiltrated lumbar gland, from a case of enkepha-

loid carcinoma of the femur, a native lad, aged 15, upon whom
the operation of amputation at the hip-joint was performed,
but who died from a recurrence of the growth in the pelvic
glands, lungs, &c. (“ Surgical Post-mortem Becords,” vol. I, 1877,
pp. 397-98.)

96. A malignant tumour (sarcoma) removed from the right axillary

region of a native male, aged 35.

It is ovoid, in shape, five inches in length, four and a half inches in
breadth, and about two and a half inches in thickness. Has
no distinct capsule, but is surrounded by a quantity of loose
cellular tissue, most of which has now been dissected off. Is
soft and succulent in consistency. Pale-white in colour. The
surface and sections broadly lobulated and smooth.

Under the microscope the structure is seen to consist of a very dense cellular
tissue, with a very small quantity of granular or faintly fibrillated inter-
cellular substance. The cells are more or less round ; about the size of
pus or mucus corpuscles, with solitary large nuclei. Larger and smaller
blood-vessels are seen plentifully distributed throughout the growth,
tunnelling it out in various directions ; their walls very delicate, and
intimately associated with the cellular structure of the tumour-tissue.
They are unusually distinct from being filled with coloured blood
corpuscles. Portions of the growth also show extravasations of blood, and
numbers of pigmented cells. Lastly, in parts, the growth has a firmer
consistency, a more distinctly fibrillated structure, and shows a large
number of lymphoid cells, rendering it highly probable that the tumour had
its primary seat in the axillary glands. The main bulk of the growth, how-
ever, is truly sarcomatous ; — the tumour is a “ small round-celled sarcoma.”

97. A sarcomatous tumour removed from the right side of the neck

of a native lad, aged 16. It was of about ten months’ dura-
tion, and very painful. The growth forms an irregular-shaped,
nodulated mass, which, on section, has a yellowish-white homo-
geneous appearance, like that of a raw potato. Its glandular
origin is readily recognisable. The consistency is somewhat
soft.

Under the microscope the structure consists of lymphoid tissue, — small round
nucleated cells, and a delicate small-meshed reticulum of connective tissue,
but the cell-elements are greatly in excess, and, even in brushed out
sections, greatly preponderate over the stroma, which indeed in parts
seems to be quite wanting ; and with the round cells are some elongated
and spindle-shaped. The tumour-mass is formed entirely by a series of
altered lymph-gland3 fused together, and involving the surrounding tissues
to a limited extent.

With this tumour is preserved a chain of lymphatic glands from the
left side of the neck, found similarly affected on post-mortem
examination. These have an almost identical structure, though

382 PERSISTENT THYMUS GLAND. [series x.

Hie purely Jvmphoid characteristics are more pronounced than
in the “ tumour,” and numbers of small circumscribed abcesses —
disintegrating and suppurating gland-tissue— are to be seen
in sections placed under the microscope. Such suppuration was
quite probably pysemic,-— the patient dying from this cause
(pyaemia.) (See “ Surgical Post-mortem Records,” vol. I, 1879,
pn. 581-82.) ( Presented by Professor K. McLeod.)

98. “ Syphilitic bubo.” An indurated and enlarged lymphatic gland,

dissected out of the groin of a native (male) patient, aged 40,
suffering from a true, primary, Hunterian sore (hard chancre).
(Presented by Dr. E. Lawrie.)

99. Pigmented inguinal and axillary glands, from a “tattooed” New

Zealander (Maori), a seaman, aged 25, who died in hospital.
These glands all show dark-bluish granular pigmentation of
their proper (adenoid) structure. The deposit is both extra
and intra-cellular ; is specially abundant in the peripheral follicles,
while the central portions of each gland are mostly free of
infiltration, and quite normal-looking. There is also a bluish
staining of the endothelium of the lymphatic vessels, and of the
fat accumulated in and near the gland-capsules. The pigment
matter is probably gunpowder.

100. “Heart, lungs, and thymus from an infant three days’ old.”
(Ewart.)

101. “ Persistent thymus gland, from a lad of 18 or 19, who died
from rupture of an enlarged spleen. No other organs were
diseased.” (Colles.) (Presented by Dr. J. M. Coates, Central
Jail, Ilazareebagh.)

102. “Avery good specimen of persistent thymus gland, from a
child about nine years old.” The gland is deeply lobulated ;
consists of two lateral portions - the left being the larger — which
overlap the front of the trachea at its bifurcation, and then
descend in front of the heart, which is almost hidden by them.
A little loose cellular tissue connects the gland with the peri-
cardium. (Presented by Professor C. 0. Woodford.)

103. Pseudo-cystic hypertrophy of the pineal gland. Found on
post-mortem examination of the brain of a native female, aged
20, who died of pneumonia after child-birth.

This condition appears to have been brought about by some form of
degenerative softening succeeding hypertrophy of the gland, for
it is enlarged to about three times its normal size.

On scraping the walls of the pseudo-cyst, — which are here and there
raised into little papilliform excrescences, — nothing abnormal in
structure can be detected by the microscope. A connective tissue
basis-substance is seen, forming a close-meshed reticulum, in
which are imbedded larger and smaller sized round, granular,
mono-nucleated cells, and also a large number of irregular-shaped
or rounded “ corpora amylacea ” — a structure, in fact, closely
resembling the normal composition of this gland.

SERIES XI.]

INDEX.

383

Series XI.

INJURIES AND DISEASES OF THE KIDNEYS

AND URETERS.

INDEX TO THE SERIES.

A.— KIDNEY.

I. — Rupture, or effects of external injury, 1, 2, 3, 4, 5.

2— Hypertrophy, 6, 7, 8, 9, 10, 11, 13, 16, 87-

3— Atrophy : —

(«) In consequence of disease, 9, 10, 12, 13, 14, 15, 16.

(b) Senile, 17, 18, 19, 20, 21.

4. — Hyperjemia (passive), 22, 23, 24.

5. — Inflammation or Acute Nephritis, 25, 26, 27, 28, 29.

6. — Chronic Nephritis : —

(a) Large white kidney (tubal nephritis), 30, 31, 32, 33, 34, 35,

36, 37, 59, 04, 65, 66.

( b ) Small contracted kidney (intertubal nephritis), 38, 39, 40, 41,

42, 43, 44/45, 46, 47, 48, 49, 50, 81.

7. — Suppurative nephritis : —

(a) From injury or disease in genito-urinary tract, 51, 52, 53.

(b) Pyiemic, 54, 55, 56, 57, 58.

1 8.— Amyloid or albuminoid degeneration, 33, 35, 42, 46, 49, 59, 60, 61,
62, 63, 64, 65, 66, 69.

9. — Fatty degeneration, 67, 68, 69, 70.

10. — Scrofulous (phosphatic) degeneration, 71, 72, 73.

II. — Cystic degeneration or Cystic disease, 74, 75, 76, 77, 78, 79, 80,

81, 82, 83, 84.

12. — Pyelitis, 52, -85, 86, 87, 88, 89, 90.

13. — Hydro-nephrosis and Pyo-nephrosis, 87, 91, 92, 93, 94, 95, 125.

14. — Calculus in kidney, 86, 87, 90, 92, 96, 97, 9S, 99, 100, 101.

15. — Infarctions : —

( a ) Simple, 102.

(b) Pysomic, 103.

16. — Morbid growths : —

(«) Tubercular, 104, 105, 106.

(b) Gummatous (syphilitic), 107.

(') Carcinomatous, 108.

(d) Sarcomatous, 109.

384

RUPTURE OF THE KIDNEY.

[SEEIES XI.

17. — Malformations, &c. : —

(a) Horse-shoe kidney, 86, 110, 111, 112, 113, 114, 115, 116.

(b) Misplaced kidney, 57, 117, 118, 119.

( d ) Kidney with double ureter, 121, 122.

B.-URETER.

1. — Dilatation, 52, 91, 123, 124.

2. — Impaction of calculi, 91, 98, 123, 125.

1. ° Ruptured kidney. The organ is much lacerated on its concave

border near the hilum. The pelvis and ureter are also injured.
The accident was caused by a blow from the fore-foot of a horse
at 5 p.m. on the 25th October 1847, the patient being a native
of Debrughur. He passed bloody urine and clots of blood per
anum. He died at 10 a. m. on the 27th, forty-one hours after
the receipt of the injury.

At the post-mortem there were found evidences of general peritonitis ; stomach
and intestines were uninjured. The ascending colon, at its junction with
the transverse colon, was pressed forward by a hard firm tumour, which, on
raising the gut, was found to be a mass of coagulated blood inclosed in a
sort of bag formed of false membrane. This mass, the size of two clenched
fists, escaped from the kidney, which was found embedded in its centre.
The organ was extensively ruptured, the upper fourth being entirely
detached, was separated to the extent of half an inch. The effused blood escaped
from this part. Passing behind the peritoneum, it passed into the cellular
membrane in front of the large vessels and nerves to the opposite side ;
downwards it passed as far as Poupart’s ligament behind the transverse or
iliac fascia.” ( Presented by W. J. Long, Esq.)

2. Transfixing wound of the lower third of the left kidney. The

direction of the wound is from the convex border, almost trans-
versely to the lower part of the hilum. (A piece of talc has
been placed in the same.) “ The orifices of the perforation are
smooth, and look as if the injury had been inflicted by a sharp
instrument.” (Ewart.) No history.

3. Rupture of the left kidney. The organ is shrunken and small.

The laceration is at its upper end, — a ragged wound about two
inches in length and a third of an inch deep. It reaches the
superior extremity of the hilum. From Ram Lall, a Hindu,
who fell off a tamarind-tree, a height of from 20 to 30 feet, and
sustained, besides the above injury, a rupture of the spleen (see
prep. No. 5, Series X) and a compound fracture of both bones
of the left forearm.

4. Right kidney showing several transverse and oblique lacerations

of its substance, situated on its under surface and outer margin.
One of these, an inch in length, reaches the hilum. From a
native who was run over by a buggy in the streets. The liver
was also ruptured ( see prep. No. 263, Series IX), and all the
ribs of the right side of the thorax fractured.

SERIES XI.]

HYPERTROPHY OF THE KIDNEY.

385

5. Rupture of the left kidney. The laceration is situated on the

anterior surface, a little below the centre of the organ. It is
an inch and a half in length and from a fourth to a third of an
inch in depth ; extends transversely from the posterior or convex
border to the hilum. From a native (Mahomedan), aged 24,
who fell from the deck into the hold of a country-boat. “ He
apparently died from shock half an hour after the accident.”

( Presented by Dr. S. C. Mackenzie, Police-Surgeon.)

6. “ Enormously hypertrophied kidneys, which are three or four times

in excess of th'eir normal size. The increase is exhibited equally
in the cortical and medullary portions of the organs.” (Ewart.)
No history.

-7. The kidneys of a Negro who suffered from diabetes and died in
hospital of pleuro-pneumonia. Both are large ; the surfaces
smooth, but dotted over irregularly with very small serous cysts.

< The cortical and pyramidal portions are about equally hypertro-
phied, and hyperaemic (in the fresh state). The Malpighian
capsules were large and prominent. There is no material alter-
ation in the secreting structure except that of overgrowth, —
the result of increased functional activity, in illustration of which
these organs have been preserved.

'8. Another similar specimen. Hypertrophy of the kidneys in con-
sequence of increased functional activity in diabetes. The right
weighs , the left 9 ounces. The renal substance was dark, con-
gested, and juicy ; the structure generally somewhat coarse-
looking, but otherwise healthy. — From an East Indian (male),
aged 37. (“ Medical Post-mortem Records,” vol. II, 187G, p. 48.)

9. The kidneys of a prisoner who died in the Presidency Jail from

chronic dysentery. The left kidney is extremely atrophied ; the
secreting structure has almost entirely disappeared ; the pelvis is
expanded, and the commencement of the ureter about throe
times its natural diameter. The right kidney shows compensa-
tory hypertrophy. Its blood-vessels are enlarged, and the
ureter a good deal dilated. It weighs 5} ounces ; the left
(atrophied) kidney only 7 drachms.

10. Hypertrophy of the left kidney with atrophy of the right. The

former is large, the capsule thickened, the surfaces coarsely
granular. In the fresh condition the organ was darkly con-
gested, and the Malpighian tufts were prominent, and of a deep-
red colour. The right kidney is very small. Its capsule
thickened and leathery ; the secreting structure greatly reduced
and disorganised; the pelvis dilated. The compensatory
hypertrophy of one organ in consequence of atrophy of the other
is well illustrated in this specimen. — From a European (male),
aged 59.

HI- Two kidneys. — The right apparently congenitally atrophied, and
weighing only two ounces. It is about two and a half inches
long, an inch and a half wide, and half an inch in thickness.
The left kidney shows complementary or compensatory hyper-
trophy. Its structure is somewhat coarse-looking, but otherwise
healthy. Weight G ounces. — From a European (male), aged 48,

386 ATROPHY OF THE KIDNEY. [series xi.

who died from cerebral apoplexy. (“ Medical Post-mortem
Records,” vol. II, 1877, pp. 4G5-66).

12. “ A remarkably atrophied kidney from a subject in the dissecting-

room. The whole of the secreting and medullary part has dis-
appeared, and the relics now consist of a shrunken pelvis, from
which is seen springing an atrophied ureter.” (Ewart.)
( Presented by W. Harrison, Esq.)

13. “ Atrophy of the right kidney, from a patient in the College

Hospital. The organ is about one-third of its normal dimensions.
The left kidney exhibits compensatory hypertrophy.” (Ewart.)
( Presented by Professor F. J. Mouat.)

14. “The left kidney, from a patient who suffered from enteritis.” ~~

The kidney is greatly atrophied. It is about the size of a
walnut, but flattened. The surfaces are slightly nodulated.
The capsule is thickened in parts ; in others so blended with the
secreting structure as to be almost indistinguishable from it.
On section a fibroid appearance. is presented owing to atrophy of
the proper renal structure, and the presence of broad bands of
fibrous tissue passing upwards into the same from the pelvis,
which is small and contracted. Much yellow fat occupies the
calyces, and extends into the kidney parenchyma, taking the place
of the secreting structure. The latter, in fact, can only be
demonstrated at the periphery, and here has a thickness of from
one-third to a quarter of an inch, — the cortical and pyramidal
portions being blended together.

Under the microscope sections taken from this part exhibit an excessive develop-
ment of well-formed connective tissue with numerous nuclei, displacing and
substituting the secreting structure. The growth appears to be thickest
just beneath the capsule, and to proceed centripetally. The tubuli uriniferi
are small, contracted, and shrunken; the Malpighian tufts have almost
completely disappeared. The epithelium is granular generally, but in parts
quite normal A few small cysts, with opaque fatty contents, are also
discerned. ( Presented by Assistant Surgeon Gopal Chunder Roy, Howrah.)

15. Kidneys from a native male, aged 18, who was admitted into

hospital in a moribund condition, and died from pneumonia of
both lungs. The left kidney is remarkably atrophied, and weighs
only three-fourths of an ounce. The right is larger by about
five times, but still also atrophied and granular ; weighs 3| ounces.

The larger kidney, examined microscopically, shows considerable overgrowth of the
intertubular connective tissue, both in the nucleated and fully formed
type, — the former predominating. The arteries are large, and have thick walls
The secreting (lining) epithelium is in parts quite normal, in others is
swollen, and presents a granular condition from fatty metamorphosis. Many
of the uriniferous tubules are found wide and distended, or distorted; others
empty. Here and there the Malpighian capsules are undergoing cystic
transformation. In the left kidney a mere shell of secreting structure
exists, the rest is formed by a dilated condition of the pelvis and calyces.
The capsule is thickened and fibroid.

16. The kidneys, ureters, and urinary bladder of a native male,

(Mahometan), aged 50, who died from cirrhosis of the
liver, &c.

SERIES XI.]

SENILE ATROPHY.

387

The right kidney is quite rudimentary, but its ureter is well formed
and pervious. It opens, however, into the prostatic portion of
the urethra , and not into the bladder.

The left kidney shows compensatory hypertrophy. Its ureter is normal,
and terminates, as usual, in the bladder. The latter thus
presents only a single orifice at the base of the trigone, that of
the left ureter ; there is no corresponding opening on the right
side.

The right kidney is represented by a glandular nodule, flattened^ from
'before backwards, and about the size and shape of a French
bean.

A scraping from it, placed under the microscope, presents a few obsolete Malpighian
capsules and uriniferous tubules, and consists almost entirely of highly
nucleated connective tissue, with blood-vessels, and small lobules of fat.
The ureter, however, is well formed, and the pelvis and calyces, though very
rudimentary, are still recognisable.

This right kidney was found (surrounded by a good deal of adipose
tissue) in the usual position, to the right of the vertebral column
and beneath the liver. It received a small renal artery from
the abdominal aorta, and two or three small renal veins emerged
from it to join the vena cava ( see preparation). The ureter,
as above stated, opens into the prostatic portion of the urethra,
immediately to the right of the veru montanum. It is pervious
throughout, but, about an inch and a half from its renal origin,
a small dark calculus, the size of a rice-grain, may be seen
encysted in its walls, leaving, however, the channel quite free.

At "the urethral end, the orifice of termination is as large as a
crow-quill. The left kidney occupied the usual position. The
bladder is quite healthy. The left kidney weighs 63- ounces ; the
right one drachm. ( See further, “ Medical Post-mortem Records,”
vol. Ill, 1880, pp. 573-74.)

17. Senile atrophy of the kidneys,— the right weighing 3| ounces, the

left 4 ounces. Apart from a slight roughening of the surfaces
and a comparatively greater reduction of the cortical than the
pyramidal structure, there is nothing abnormal in the condition
of these organs. — From a native male, aged 45.

18. Senile atrophy of the kidneys. From a native female, aged GO,

who died of pneumonia. Both organs are small. The cortical
and pyramidal portions in each appear to have undergone about
equal and proportionate shrinking. The capsules are a little
thickened, and do not strip easily. The right kidney weighs
3, and the left 3i ounces.

19. Senile atrophy of the kidneys. Both organs are small. The

capsules slightly adherent. The secreting structure, both cortical
and medullary, is seen on section to be reduced and shrunken. #
The right weighs 3^, and the left 3| ounces. — From a native
male, aged about 70, brought into hospital moribund, — apparently
from chronic starvation and general senile decay.

20. Senile atrophy of the kidneys. — From a native male, aged 55,
who died from internal strangulation of the bowels. Both

388 PASSIVE IIYPERiEMIA. [seeies xi.

organs are small, their surfaces smooth, but scattered over with
a few minute superficial cysts. The capsules peel easily. On
section the renal structure is found healthy, though everywhere
reduced or shrunken.

21. Senile atrophy of the kidneys. Both organs are small ; the sur-

faces are smooth, but show a few simple serous cysts, and some
are found more deeply situated on section. The secreting struc-
ture is firm, but atrophied, — the cortical and pyramidal portions
participating about equally in this change. — From a native
male, aged 60, who died in hospital from remittent fever.

22. Specimens of large, heavy, passively congested and hypertrophied

kidneys, associated with long-standing obstructive heart disease,
and great dilatation of the right chambers. When fresh, venous
blood dripped freely from them on incision. The surfaces are
smooth ; the capsules stripped easily. The lungs presented
scattered patches of blood extravasation (apoplexies) ; the liver
was “ nutmeggy.”

23. Kidneys from a case of cholera. A native female, aged 28, who

died from a second attack of the disease, having recovered from
the first, about four months previously.

Sections from these kidneys under the microscope show (1) much pigmenta-
tion,— the pigment being dark and in the form of minute dots or granules
scattered irregularly along the course, and within the uriniferous tubules. This
pigmentation seems to be of some standing, and probably represents the re-
mains of extensive ecchymosis during the intense congestion of the first
attack of cholera. (2) Recent haemorrhage into the Malpighian tufts, and
along the sides of the convoluted tubes ; the walls of the renal arterioles are
themselves stained. Both the above conditions most marked in the cortical
structure. (3) Great swelling of the intratubular epithelium. These cells
(epithelial) are enlarged to two or three times their normal size, their proto-
plasm highly granular (“cloudy swelling ”), and at the same time presenting
in many cells a minute dotted yellowish transformation (? colloid change).
The tubules, further, in many instances, are completely blocked, partly owing
to intumescence of the epithelia, partly to shredding of the same, with
denudation of the basement or lining membrane. The epithelial changes
appear to be most marked in the pyramidal structure.

24. Kidneys from a fatal case of puerperal eclampsia,— a native female,

aged 19, a primipara. Both are enlarged, and, on section, the
pelvis and calyces are seen considerably dilated or expanded, and
their lining membrane much injected and vascular. The latter is
probably attributable to the pressure exercised by the gravid
uterus upon the ureters. The pyramidal structure showed a
very dark-purple congested condition in the recent state ; the
cortex paler, fatty-looking, and incipiently atrophied. Much
opaque, milky-looking fluid exuded from the papillae on pressure.

On microscopic examination sections from these kidneys displayed all the
characters of incipient tubal nephritis. The uriniferous tubules large,
dilated, contorted, and in parts ruptured. Their epithelial lining swollen,
the cells large, full of minute dark granules, and in parts proliferating.
Some fatty metamorphosis of the tubular contents is also visible. No marked
intertubular change, except a little abnormal nuclear proliferation around
the walls of the small arteries in the cortex.

series XI.]

THE KIDNEYS IN CIIOLEKA.

389

The patient was attacked with convulsions (eclampsia) during labour,
and died, comatose, forty hours after delivery. The urine was
highly albuminous, and very scanty. (See further, “ Obstetrical
Post-mortem Records,” vol. I, 1877, pp. 367-68.)

25. Kidneys from a native male, aged 32, who died in the reaction

stage of cholera. The organs exhibit very characteristic appear-
ances. The pyramidal structure is intensely ecchymosed, the
cones dark-red and prominent (in the fresh state) ; the cortical
structure is less vascular, of a pinkish- white colour from intra-
tubular desquamation of epithelium.

The latter is confirmed on microscopic examination. The tubules are found dilated,
distorted, and filled with swollen, granular, partly or wholly detached epi-
thelium. The Malpighian tufts are enlarged, their capillary vessels appar-
ently engorged ; free blood cells — from rupture, and extravasation —are
seen within the capsules.

Intense congestion with intratubular desquamation and obstruction are
the principal morbid changes displayed by these kidneys.

26. Kidneys showing, very characteristically, the morbid anatomy of

acute desquamative nephritis, such as is commonly met with
when death occurs in the reaction stage of cholera. The patient,
a European seaman, aged 25, was admitted into hospital on the
23rd May 1879, at 2 a.m., and died on the 29th, at 11-45 p.h.
During the last four days preceding death the urinary secre-
tion was totally and entirely suppressed.

The kidneys are large and swollen ; the right weighs 6 and the left
8 ounces. The capsules stripped easily. The surfaces are for the
most part smooth. On incision, in the fresh state, much fluid
dark blood came away freely from the renal parenchyma.

The pyramidal structure presented a highly congested appearance ; the
cones of the same being prominent, and contrasting markedly
with the cortical structure, which was pale and somewhat
anaemic looking,— had a streaky opaque appearance from intra-
tubular epithelial desquamation. The papillae, on pressure, exuded
thick, milky-looking fluid or juice. ( See further, “Medical
Post-mortem Records,” vol. Ill, 1879, pp. 163-64.)

27. The kidneys of a native male (Hindoo), aged 40, who was admitted

into hospital suffering from polyuria or diabetes insipidus. He
used to pass from 50 to 180 ounces of urine in the twenty-four
hours. It was clear and limpid, like distilled water ; free from
sugar, albumen, bile, phosphates, and chlorides ; and of a specific
gravity of from 1001-2. He died (while improving under treat-
ment) from a sudden attack of cholera.

The kidneys, in the fresh state, were of about normal size, but darkly
congested, soft, and juicy ; dark blood dripped freely from the
incised surfaces. The capsules stripped with much difficulty,
tearing away the kidney parenchyma. The cortical structure is
a little reduced and fatty-looking, — has, in both organs, a streaky
yellowish-white colour ; the pyramids are large and dark-red.
No amyloid change.

390

NEPHRITIS I12ERRHAGICA.

[series XI.

On miscroscopic examination the secreting structure is found in a state of catarrhal
inflammation, — the epithelium lining the tubules swollen and granular, ami
much detached in parts, so as to form aggregations of three, four, or more
coherent cells, or long cylindrical casts of the same. The Malpighian tufts
are large and dilated.

( See farther, “ Medical Post-mortem Records,” vol. II, 1878,
pp. 863-64.)

28. Kidneys somewhat swollen and enlarged, and presenting a very

remarkable purpuric condition, the surfaces of both organs being
covered with innumerable, minute, dark-purple, points of blood
extravasation and pigmentation. These are not larger than a
pin’s head, and very distinctly circumscribed. The renal paren-
chyma is seen, on section, to be similarly affected,— especially the
cortical portion.

lu microscopic sections this minutely ecchymosed condition is seen to be chiefly con-
fined to the superficial layers of the cortex, and particularly to the surfaces
of the kidneys. Dark granular pigment matter (blood) is found to compose
the irregularly rounded dots scattered over these portions of the renal tissue,
and also fills some of tin tubules, giving them a dark-red appearance.
The intratubular epithelium in both the cortex and pyramids is affected,
particularly in the former,— swollen, granular, and shreddy.— producing dis-
tension, distortion, and blocking of numerous tubules, and is found generally
loosened from the basement membrane. No marked intertubular change.
(Nephritis hsemorrhagica.)

From a native female, who died from carcinoma of the rectum, &c.

29. Kidneys showing a remarkable purpuric condition. Their surfaces
are thickly covered with minute blood-extravasations or ecchy-
moses, about the size of pins’ heads, arid these are seen to extend
also into the cortical structure for a considerable depth, as seen
on section.

From a native female, aged 20, who died of chronic dysentery.
She was much emaciated and anaemic, but there were no signs
or symptoms of either purpura or scurvy.

Sections from these kidneys, examined microscopically, exhibit no Uitei.ition in the
secreting structure, d he ecchytnoses are almost entirely confined to the
surface, in connection with the stellate plexuses of veins here situated.
Those affecting the deeper parenchyma are also chiefly limited to the
upper strata of the cortex, being here associated with the interlobular veins.
In several sections these veins appear to be almost completely thrombosed,
and dilated, at irregular intervals, to two or three times their normal
calibre, so as to present a somewhat moniliform appearance. (“ Medical
Post-mortem Records,” vol. II, 1878, pp. 725-26.)

30. Large white kidneys (tubal nephritis) of Bright. Both organs
are°increased in size and weight. Have a pale, anaemic, waxy-
looking appearance. The cortical structure is increased. “ The
patient had all the symptoms of uraemia, and the urine passed
by him was albuminous.” ( Presented by Dr. Ewart.)

31. “ Large white kidney of Bright. From a patient named Udoito,

aged 22, a washerman by trade. He . was an habitual rum-
drinker. Had ascites and anasarca of the lower extremities.
The kidneys arc somewhat enlarged, their surfaces smooth, and

SERIES XI.]

TUBAL NEPHRITIS.

391

the one that has been incised shows a pale-yellowish anaemic
condition, with disproportionate hypertrophy of the cortical
portion.

32. Tubal nephritis. Large white kidneys, from a case of Morbus

Brightii, — a young native female, admitted into hospital with
general anasarca and albuminuria. The organs are large, their
surfaces smooth, though congenitally lobulated. On section, pale
and anaemic. The cortical structure is hypertrophied and fatty.

33. Large mottled white kidneys, showing, also, amyloid or albuminoid

degeneration, and giving a characteristic reaction with solution of
iodine.

From a native male patient, aged 50, who died from uraemia. There
was anasarca of the lower extremities, and a highly albuminous
urine. ,

34. Large mottled white kidneys (tubular nephritis). From a native

lad, aged 17. Both organs are large, and their surfaces smooth.
On section the renal parenchyma presents a pale, anaemic appear-
ance, and the cortical structure is hypertrophied.

The patient was admitted with ascites and oedema of the lower extrem-
ities. “ About two months ago nrst noticed puffiness of the face
and hands, since which period the oedema has gradually become
general, and the abdomen has filled with fluid.

On the evening of admission paracentesis abdominis was performed, and
about 1(38 ounces of pale serous fluid removed. This gave the
boy considerable relief. Next morning he complained of diffuse
pain all over the abdomen ; was troubled with incessant vomiting,
and, in this miserable condition, remained for two days, and at
last died quite exhausted from the (acute) peritonitis. (See
further, “ Medical Post-mortem Records,” vol. I, 187T,
pp, 205-6.) (Presented by Professor Chuckerbuttv.)

35. Kidneys large, mottled, and white, — tubular nephritis, showing also

amyloid fh filtration. — From a native male, aged 28, who died
from Morbus Brightii (acute albuminuria). (Presented by
Professor Norman Chevers.)

36. L arge white kidneys. Both are abnormally lobulated (congenital).

The capsules strip easily, and are thin and transparent. The
surfaces are smooth, but mottled. The kidney substance also
presents, on section, a remarkably mottled or marbled condition ;
the cortical structure is highly fatty ; the pyramids dark-pinkish
in colour (in the fresh state.)

Examined microscopically, the morbid histology of tubal nephritis is well marked,
l'he tubuli uriniferi are seen enlarged, dilated to two or three times their
normal calibre; the lining epithelium in a state of proliferation, and highly
fatty. Granular fatty coats are also observed within some of the tubules ;
and, in parts, free fat in the intertubular tissue.

From a native (female), aged 30, who died in hospital of Morbus Brightii.
(“ Medical Post-mortem Records,” vol. II, 1878, pp. 801-02?)

37. Large white kidneys (tubular nephritis). Both are somewhat

large. The capsules strip pretty easily. The surfaces are a
little rough. On section the cortical structure is highly fatty,
pale, and anaemic. The pyramidal structure of rosy -pink colour.

392

INTERTUBAL NEPHRITIS.

[series XI.

Weight of the right kidney 5f ounces, of the left 5 ounces.

On microscopic examination the following are the chief alterations in structure
discovered. (1) Malpighian bodies large, with enormously dilated “ tufts ’
and distended capsules. (2) Tubules distended, dilated, distorted, — filled
with highly granular epithelial debris, consisting of granular and fatty
matter with nuclei, and a few entire swollen epithelial cells. Large casts
formed of this material are squeezed out of the tubules (and float free in
the field) under the pressure of the covering glass. (3) No marked inter-
tubular infiltration, but some thickening of the intertubular connective
tissue in parts. (4) An aggregation of leucocytes and red blood corpuscles
around, and only in the immediate vicinity of the Malpighian capsules, as
if from transudation or emigration from the over-distended tufts of the
same. The characters are, therefore, those of advanced “ large white
kidney” of Bright, with commencing contraction of the organ, due to
hyperplasia and contraction of the intertubular connective tissue, independ-
ent of any nuclear proliferation in this situation.

From a native female, aged 22, who died of Morbus Brightii. (“ Medical
Post-mortem Records,” vol. Ill, 1879, pp. 73-74.)

38. A highly lobulated, cirrhosed -looking, contracted kidney. The

cortex is seen, on section, to be reduced to a mere line, the
pyramids are large, and almost reach the surface. (. Presented by
Professor Norman Chevers.)

39. Small, contracted, and highly granular kidneys, from a native male

patient (Hindu), aged 48, who was admitted into hospital with
acute pericarditis, and “ died suddenly from syncope the day after
admission.”

40. Very typical examples of granular contracted kidneys,— -chronic
Morbus Brightii. Both organs are greatly reduced in size.
The capsules are much thickened, and peel with difficulty. The
surfaces are remarkably granular, rough, and exhibit several
small cysts. The cortical structure is seen (in the kidney that
has been incised) to be greatly atrophied, forming a mere
thin rim at the periphery of the organ. The pyramids are
also shrunken and small, but not to so great a degree as the
cortex.

The left ventricle of the heart was greatly hypertrophied {see prep.
No. 53, Series VI).

41. Kidneys from a Hindu (male), aged 18, who was admitted into

hospital in a moribund condition and died an hour after. There
was great embarrassment of the breathing, and tumultuous
heart’s action. The kidneys are contracted, small, and distinctly
granular. There is great disproportion between the cortical
and pyramidal structures,— the former appearing as a mere rim,
only a few lines in thickness, Both are well marked specimens
of the “ small, red, contracted” kidney of Bright, and are
preserved in illustration of the rare (but occasional) occurrence
of this form of kidney disease at such an early period of life.^

42. Granular and contracted kidneys, showing also amyloid infiltra-

tion. They are small in size ; the surfaces rough, and with
numerous minute serous cysts. Here and there, irregularly,
the Malpighian tufts and small arteries present a glistening

SERIES XI.]

CHRONIC BRIGHT’S DISEASE.

393

semi-transparent appearance from amyloid or albuminoid degen-
eration, and give the characteristic reaction with iodine.

The subject was a native male (Mahomedan) who died in hospital
from Morbus Brightii and cirrhosis of the liver. The liver
Exhibited no amyloid change.

43. A preparation intended to illustrate the association of chronic

Bright’s disease with cardiac hypertrophy. The kidneys and
heart are put up together. The former are most typically small,
granular, and contracted — reduced to less than half their normal
size. The heart shows great thickening of its muscular walls,
particularly of the left ventricle. There is no valvular disease.

From a native male, aged 40, who died in hospital from urajmia.

44. Small, contracted, and granular kidneys, — chronic Morbus Brightii.
They are firm and resistant on section. The cortical structure
is greatly reduced ; measures only from two to three lines in
thickness. The surfaces of both kidneys are thickly covered
with small serous cysts, varying in size from a pea to a sago-
grain, Weight of the right 2^ and of the left 3£ ounces.

From an East Indian female, aged GO.

The whole of the arch of the aorta, the thoracic and abdominal aorta,
the vessels of the circle of Willis, &c., were highly atheromatous.
(. See further, “Medical Post-mortem Records,” vol. I, 1875,
pp. 505-6.)

45. Chronic Morbus Brightii. Highly granular and contracted

kidneys. The right weighs 3^ and the left 3^ ounces. — From a
native female, aged 38, who died in hospital. There was hyper-
trophy of the heart, which weighed 16 ounces, and extensive
atheromatous degeneration of both the thoracic and abdominal
aorta, &c. (“Medical Post-mortem Records,” vol. II, 1877,
pp. 457-58.)

46. Kidneys highly granular, contracted, and also amyloid.

Microscopic examination confirms this. The amyloid infiltration is

extensive, — affects the Malpighian tufts, arteries of the cortex,
and straight arteries of the pyramids. Many of the epithelial
elements, crowded within the tubules of the medullary portion
of each kidney, appear also to be thus transformed. There is an
abundant nuclear proliferation of the connective tissue of the
cortex, with commencing fibrillation of the same in parts ;
compression of the Malpighian capsules and uriniferous tubules ;
and fatty degeneration with atrophy and disintegration of the
intratubular epithelium.

From a native male, aged 40. The liver was also amyloid. ( See further,
“Medical Post-mortem Records,” vol. I. 1877, pp. 381-82.)

47. Chronic Bright’s disease, — earlier stage. Both kidneys are some-

what reduced in size, the left in particular. The surfaces are
rough and finely granular. The pyramids present a dark-
purple colour from recent venous congestion (in fresh state) ; the
cortical structure is paler and incipiently atrophied. These
changes are more marked in the left than right kidney, and, near
its surface, three or four simple serous cysts may also be seen,
— each about the size of half a pea.

394

GRANULAR, CONTRACTED KIDNEYS.

[series XI.

Examined microscopically sections show (1) much nuclear proliferation at thecortico-
medullary junction,, extending into the cortex proper, and also into the
pyramids. (2) Incipient transformation of nuclear growth into connec-
tive tissue — especially in the smaller kidney. (3) Abnormal aggrega-
tion of the Malpighian capsules, with distortion and varicosity of the tubuli
uriniferi, — also more marked in the left kidney. (4) Epithelial lining of
tubules normal, or swollen and granular, or entirely wanting, and thus
many empty tubules are found, and others filled with transparent hyaline
material (casts), — especially in the pyramids. No amyloid change.
(5) In the larger kidney a good deal of turgescenee and fullness of
the vessels composing the Malpighian tuft. (6) In both organs an
admixture of red blood-cells (from extravasation) with the nuclear prolifer-
ation above described. All these changes are very characteristic of advanc-
ing granular degeneration, but peculiar in being especially marked at the
cortico-medullary junction.

From a young Hindu female. She was admitted into hospital in an
insensible condition, with uraemic convulsions, &c., and died,
comatose, after thirty-six hours. The urine was highly albumin-
ous and very scanty. Three weeks previously she had been
delivered (in the obstetric wards) of her second child, and had
been discharged convalescent. On post-mortem examination
large apoplectic extravasations were found in the posterior lobes of
the cerebrum {see prep. No. 7, Series VIII). (Obstetric Post-
mortem Records,” vol. I, 1877, pp. 385-86.)

48. A preparation illustrating the association of cardiac hypertrophy

with chronie Bright’s disease. The kidneys are typically small,
granular, and contracted ; the right weighs 3 and the left 3£ ounces.
The heart shows very great thickening of its walls — particularly
of the left ventricle, towards the base of which the muscular
tissue measures quite an inch and a half in diameter. The
ventricular cavity is also somewhat dilated. The heart weighs
29^ ounces. Taken from a European (male), aged 36, who died
in hospital. (“ Medical Post-mortem Records,” vol. II, 1877,
pp. 629-30.)

49. Kidneys, granular and amyloid. The right weighs 3| and the left

4| ounces. The liver and spleen also showed well-marked
amyloid or albuminoid infdtration {see preps. No. 328, Series
IX, and No. 54, Series X). From an American seaman, aged
45, who died in hospital of pulmonary phthisis. (“ Medical Post-
mortem Records,” vol. II, 1878, pp. 729-30.)

50. Very marked granular, small, and contracted kidneys, showing,
under the microscope, all the characters of advanced interstitial
nephritis (chronic Bright’s disease). There was much hyper-
trophy of the heart, which weighed 12 ounces ( see prep.
No. 55, Series VI). — From a native female, a jn-ostitute,
aged 35.

51. Acute suppurative nephritis. The kidneys of a native male

patient, aged 50, upon whom the operation of lateral lithotomy
was performed for the removal of a “ mulberry ” calculus, the
size of a walnut. These organs are occupied by numerous small
abscesses and points of incipient suppuration, distributed
diffusely, both at the surfaces and also throughout the renal paren-

SERIES XI.]

SUPPURATIVE NEPHRITIS.

395

chyma. Tlie patient died on the sixth day after the operation.

( See further, “ Medical Post-mortem Records,” vol. I, 1878 p. 24.)

52. Urinary bladder, ureters, and kidneys of an East Indian woman,
Louisa A. — , aged 27, who died from acute suppurative nephritis
after the removal of a calculus from the bladder.

The stone was the size of a hen’s egg. The urethra was first dilated, but this
being insufficient, two small lateral incisions were made in its walls, and the
calculus then extracted with an ordinary lithotomy forceps.

The patient was in a very weak and debilitated condition before the operation, and
had been suffering from fever ever since her admission into hospital. There
was great irritability of the bladder, and the urine was very offensive and am-
moniacal. The symptoms of stone in the bladder had existed for about a year.

The condition of the parts preserved is as follows : — The urethra easily
admits two fingers, its mucous lining is torn and shreddy. The
urinary bladder (found contracted and empty) has very thickened
walls ; the mucous membrane superficially ulcerated, and, at the
fundus, presents two or three circumscribed shallow dilatations or
pouches. The left kidney is enlarged to about twice its normal
size. The surface was intensely vascular and injected in the
recent state, and may be seen covered with innumerable circum-
scribed abscesses, varying in size from a sago-grain to a horse-
bean, — the majority small. They contain a few droplets of thick
yellow pus. The kidney-substance generally is very soft and
flabby. About two drachms of reddish, grumous-looking pus found
in the pelvis. Both cortical and pyramidal portions are exces-
sively hypenemic, and thickly studded with minute suppurative
foci. The pelvis and calyces of this kidney are widely dilated, —
their lining membrane highly vascular, rough, and ulcerated.
The ureter is dilated at irregular intervals, and its coats much
thickened. The right kidney is atrophied, its capsule thickened,
its substance acutely inflamed, and infiltrated with numerous
minute circumscribed abscesses — fewer, however, than in the left
kidney. There is eccentric expansion of the pelvis and calyces, the
lining membrane of which is soft, highly vascular, ulcerated,
and even sloughy in some parts. The ureter is dilated, but more
uniformly than the left. Its coats are throughout thickened.
(See further, “Surgical Post-mortem Records,” vol. I, 1874,
pp. 55-56.)

53. Acute suppurative nephritis (surgical kidney). The preparation
exhibits the right kidney, — much enlarged, highly vascular and
juicy. Its surface is rough and finely granular from the pro-
jection of numerous points of suppuration, either solitary or
single, or aggregated into little patches. Each separate point is
about the size of a swan-shot, of yellowish-white colour, semi-
solid consistency, and surrounded by a delicate, but distinct
hypersemic zone. Similar points of suppuration are scattered
throughout the cortical and medullary portions of the organ,
as seen on section. The pelvis and calyces are highly injected
and ecchymosed (in fresh state). The left kidney (not preserved)
showed intense vascularity, but no points of suppuration. From
a European, aged 37, who had stricture of the urethra with

396

SUPPURATIVE NEPHRITIS (PY7EMIC). [sebies xi.

cystitis, and who died from diffuse suppuration in the recto-
vesical cellular tissue, following Cock’s operation (puncture of the
bladder behind the prostate) for retention of urine.

54. “ The kidneys illustrating abscesses both in the cortical and medul-

lary portions, the result of pyaemia.” (Ewart.)

55. Kidneys of an East Indian, aged 27, exhibiting numerous

haemorrhagic infarctions and points of incipient suppuration.
The infarctions in the right kidney are distinctly circumscribed,
vary in size from a horse bean to a millet-seed. The larger of
these are situated along the outer border of the kidney, and are
wedge-shaped on section. Similar lesions may be seen affecting
the deeper renal parenchyma — both cortical and medullary. The
left kidney shows much the same appearances, and, in addition,
a large, pale, decolourising, fibrinous clot, placed quite super-
ficially at the lower end of the organ. The patient died from
pyaemia consequent upon stricture of the urethra, treated by
dilatation (Holt’s method). Several large haemorrhagic infarc-
tions were also found in the spleen in this case ( see prep. No. 46,
Series X).

56. Kidneys infiltrated with numerous pyaemic abscesses. From a case

of suppurative synovitis, a native male, aged 50. Both organs
are larger than normal, and, in the fresh state, were much swollen
and vascular. The surfaces exhibit numerous suppurative foci,
varying in size from a pea to a pin’s head. They are distinctly
circumscribed, and surrounded by hypersemic zones of congested
vessels. Each contained a drop or two of thick pus ; and, as
may be seen in the preparation, similar minute suppurating
points are scattered irregularly throughout the cortical and
pyramidal portions of each kidney.

57. A preparation showing acute suppuration (pyaemic) of the kidneys,

which were also found abnormally placed. The surfaces and
also the deeper parenchyma of both organs exhibit numer-
ous minute, circumscribed abscesses, solitary, or in small groups
or patches. The kidney-substance generally is highly vascular
and injected. The right kidney weighs 4£ and the left, which
is smaller, 3 ounces. — From a native female, aged 60.

Both kidneys were found on the same (right) side of the abdomen, — one in its
natural position in the lumbar region, beneath the liver; the other (the
left) below it, at the brim of the pelvis, almost immediately over the right
sacro-iliac articulation. The ureter from the higher kidney passed behind
the lower one, and thence along the right wall of the pelvis to the
bladder. The ureter of the misplaced kidney passed over to the left side,
across the first piece of the sacrum, and behind the uterus and left ovary
to the left wall of the pelvis, and then opened into the bladder. It is
consequently shorter than the right ureter, but otherwise healthy. The
arterial supply of the left kidney ( see preparation) is derived from the
aorta low down, — a short branch being given off just above its bifurcation,
which passes to the right and divides on entering the hilum of the organ.

(See further, “ Medical Post-mortem Records,” vol. II, 1876, pp. 33-34.)

58. Acute suppurative nephritis (pytemic). Both kidneys are enlarged

and highly vascular. Their surfaces are covered with innumerable

series xi.] AMYLOID DEGENERATION OF KIDNEYS.

397

small solitary abscesses, or patches of suppuration, produced by the
coalescence of from fifteen to twenty or more of these suppurating1
foci. Both varieties of lesion are slightly raised, contain thick
yellowish pus, and are surrounded by dark-purplish zones of
congestion. Not only the surfaces, but also the deeper renal
parenchyma is involved, and especially the cortical structure.
— From a native male, aged 25, who died of chronic dysentery.
There were no abscesses in the liver.

59. Large white kidneys (tubular nephritis), showing also albuminous

or amyloid degeneration, and giving a very marked and charac-
teristic reaction with solution of iodine. The kidneys are large,
smooth, of a pale waxy colour, and exhibit, on section, an anaemic
and hypertrophied condition of the cortical structure. Taken
from a girl, aged 18, who died of dysentery, but who was also
suffering from albuminuria and dropsy. The spleen in this case
was very typically amyloid and “ sagoey,” ( see preps. 48
and 49, Series X).

60. Amyloid and fatty disease of the kidneys. From a case of
pulmonary phthisis. Both organs are enlarged ; their surfaces
smooth ; the renal substance, on section, moderately firm ; the
cortical structure has a yellowish waxy appearance. Both it
and the pyramidal portion of each kidney give a marked and
characteristic reddish-brown reaction with iodine. The liver,
spleen, and all other organs, were free from this change.

61. Large, pale, waxy-looking kidneys. From an East Indian male,

who died from chronic dysentery, and had also commencing pulmo-
nary phthisis. These organs illustrate very typically both the
general and microscopic characters of amyloid or albuminoid
infiltration, and give, in both cortical and medullary portions,
the characteristic iodine reaction of this form of degeneration.
Similar changes were found in the liver, spleen, intestines, &c.
( see preps. Nos. 67 and 327, Series IX, and No. 50, Series X).

62. Amyloid infiltration or degeneration of the kidneys. Both organs

are a little enlarged, pale, amemic, and waxy-looking. Solution
of iodine gives a very distinct reddish-brown reaction. The
patient, a native male, aged 30, was admitted into hospital very
low and anaemic, and with general anasarca. The urine con-
tained albumen. There was fever and also bronchitis ; — the latter
passed into pneumonia, from which he died, on the eleventh day.

Similar (amyloid) changes were found in the spleen and small intestine
(see preps. No. 51, Series X, and No. C8, Series IX).

63. Kidneys of an East Indian (male) patient, aged 27, who died from

serous apoplexy (uraemic). Both organs show a finely granular
condition of the surfaces. The capsules stripped pretty easily.
The cortical structure is pale, anaemic, and waxy-looking, dotted
oyer with bright glancing points— the Malpighian bodies, which
give a distinct reaction with iodine solution (amyloid). The
pyramids were bright pink and congested. (See further, “ Medi-
cal Post-mortem Records,” vol, I, 1874, pp. 327-28.)

398 AMYLOID DEGENERATION OF KIDNEYS. [sebies xi

64. - Kidneys from a case of Morbus Brightii,— an English seaman,

aged 37, who died from uraemia. The kidneys are extensively
diseased. Both are greatly enlarged and heavy : — the right
weighs 12§ and the left 13-| ounces. The surfaces are slightly
roughened. Capsules very thin and transparent, peal readily.
Both over the surfaces, and on section of these organs, the renal
parenchyma is seen thickly and diffusely studded with opaque,
slightly yellowish-looking deposits, the size of mustard-seed.
These appear to be points of commencing suppuration. The
cortical structure is much hypertrophied and highly fatty. The
Malpighian capsules appear as bright glancing dots, scattered
over the surface of the same, and these, as well as the blood-
vessels at the cortico-medullary junction, and the straight
arteries of the pyramids, give a distinct reddish-brown reaction
with iodine (amyloid infiltration). The whole of the kidney-
substance, and especially the pyramidal structure, shows recent
acute congestion and vascularity, and the pelvis and calyces of
each organ are similarly highly injected.

Examined microscopically, sections taken from both kidneys — from the cortical and
medullary portions of each — show (1) numerous minute ecchymoses. associat-
ed distinctly with small arteries, and perhaps most marked in the cortical
structure. (2) The presence of small depots, also closely associated with
the small cortical blood-vessels, consisting of cells and nuclei (leucocytes),
or of granular amorphous debris, — probably from degenerative changes
in the cellular infiltration ; — or, glistening yellowish more homogen-
eous depots — not amyloid, but looking like a colloid or mucoid transfor-
mation of these cell-elements. All these are most marked and numerous
in the cortex, and to their presence is apparently due the slightly granular
appearance of the surfaces and sections of these kidneys. (3) The intra-
tubular epithelium is throughout swollen, cloudy, or distinctly fatty ; many
cells are found from three to four times their normal size. All are in a state
of desquamation lying loose within the tubules, and forming also consider-
able-sized casts within them. (4) In some parts, the tubules are quite
empty, or occupied by only an amorphous molecular debris. (5) Here and
there, the swollen epithelial cells give a distinct reaction with iodine.

(6) Numbers of large, glistening, yellowish, colloid-looking or hyaline casts
are also found within the tubules (particularly of the cortex). They do not
give any reaction with iodine, — are merely coloured by it. (7) The tubules
throughout are dilated and distorted ; in many situations ruptured.

(8) The inter-tubular tissue, — except in the situation of the small depfits above
described, — remains unaffected. (9) The great majority of the Malpighian
tufts and small arteries (interlobular and afferent) exhibit amyloid infiltra-
tion, and give the characteristic reddish-brown with iodine. The tufts are
much swollen and enlarged ; the epithelium lining the capsules is, in some
of them, much loosened, and the cells large and granular. (10) The
arteries have thick walls and narrowed channels.

Such changes seem to indicate that these kidneys belong to the “ large white,” or
“ mottled” type, but complicated (1) with amyloid infiltration, and (2)
with recent congestion and vascularity, which has, in parts, all but culmin-
ated in suppuration. ( See further, “ Medical Post-mortem Kecords,” vol.
II, 1876, pp. 281-82.)

65. Kidneys from a case of Morbus Brightii,— an East Indian male,

aged 32.

Both are large and heavy ; the right weighs 9 and the left 9-| ounces.
The surfaces, though for the most part smooth, are, here and there,

sebies xi.] FATTY DEGENERATION OF THE KIDNEYS. 399

finely granular. Both the surfaces and sections present a mottled
appearance, the cortical structure being pale, amende, and highly
fatty ; the pyramidal, on the other hand, of a dark-red colour,
and congested-looking (in the fresh state). The general
parenchyma of the kidney is remarkably coarse, and its consist-
ency soft. On application of iodine solution the Malpighian
tufts of the cortex, and, to a less extent, the arteriolte rectae of
the pyramids, give a reddish-brown reaction (amyloid). The
kidneys are therefore mixed, fatty, and amyloid. (“ Medical
Post-mortem Records,” vol. II, 1877, pp. 349-5*0.)

66. Fatty and amyloid kidneys, from a native male (Mahomedan),

aged 20, who died of dysentery.

The amyloid or albuminoid infiltration of the Malpighian tufts and
small afferent arteries is well seen in thin sections, stained with
iodine, and placed under the microscope. For the rest, the
intratubular epithelium is highly fatty ; many tubules are filled,
and even blocked with fatty granular debris. Free oily particles
are also seen external to the tubules, as if undergoing absorption,
and, in addition to these tubular changes, there is slight nuclear
proliferation in the extra-tubular connective tissue. Many of the
tubules are found to contain transparent hyaline casts, which,
however, do not exhibit the characteristic reaction with iodine, —
are merely stained yellow by it. (“ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 161-62.)

67. “ Section of a fatty kidney, from a patient in the College Hospital,

who had cirrhosis of the liver, enlarged spleen, and ascites.
(Ewart.) ( Presented by Professor F. J. Mouat.)

68. Fatty kidney. The organ is enlarged, homogeneous on section, and

of a pale-waxy or yellowish colour. No history. ( Presented by
Dr. J. Ewart.)

69. Large fatty kidneys, undergoing incipient contraction, and showing

amyloid infiltration of the Malpighian tufts and small arteries.
Both organs are enlarged, and their surfaces smooth. On section,
the kidney-substance presents a pale-yellowish or lemon colour, and
is anaemic. The consistency is soft and friable. Much brownish-
yellow fat is seen deposited in and around the calyces of both
organs. From a European, aged 50, who died of epithelioma
of the tongue.

70. Enlargement of the kidneys, with advanced fatty degeneration,

“ from a case of epilepsy, aged 27.”

71. Scrofulous degeneration of the kidneys. “ Both kidneys of a

patient in the General Hospital. One kidney is quite dis-
organized, and converted into a sac containing a mortar-like
substance, found on analysis to be phosphate of lime. It is
amorphous under the microscope. The other kidney contains
sacculated dilatations filled with the same material.” (Colles.)

72. The kidneys of a European female, aged 55, who died in hospital.

The right kidney is hypertrophied, but not otherwise much
altered. The left is in a state of cystic degeneration ; has a
markedly lobulated outline, and, on section, almost the whole of
the proper renal structure is seen to have been converted into a

400 SCROFULOUS PHOSPHATIC DEGENERATION, [seeies xi.

series of large cysts. They vary in size from a hazelnut to a
walnut; are situated just beneath the capsule, but largely
excavate the kidney parenchyma. They are filled with a thick,
pasty, opaque-white, and slightly gritty material, semi-solid in
consistency, and having much the appearance of moistened plaster
of Paris (phosphatic) .

Examined microscopically, this pasty substance is granular and amorphous. On
the addition of acetic acid, large numbers of small, round, granular pus-cells
come into view, as also a considerable quantity of spheroidal and polymorphous
epithelial cells. A great deal of the granular matter dissolves, and that
which is left consists of organic particles — micrococci and bacteria — in active
movement. On the addition of strong sulphuric acid the latter become
“ still,” and an immense number of beautiful crystals (prismatic or brush-
like, &c.) of calcium phosphate become visible. ( See further, “ Medical Post-
mortem Records,” vol. I, 1875, pp. 939-40,)

73. Strumous degeneration of the kidney. The preparation exhibits

the left kidney of a native female, in which the secreting struc-
ture has been almost entirely converted into a series of large
rounded cysts, — one or two the size of a potato, the rest smaller.
The majority of these is occupied by a thick, pasty, yellowish-
white material, chiefly phosphatic in composition. A few of the
cysts contain only clear serous fluid.

74. “ Kidney showing a great number of cysts on its surface, contain-

ing a translucent serous-looking fluid, and varying in size from a
millet-seed to that of a pea. At one end, however, there are two
covered by thickened, opaque capsules as large as walnuts.” (Allan
Webb.) ( Pathologia Indica, No. 270, page 209.)

75. “ A large cyst in the left kidney, from an old subject in the dissect-

ing-room.” The cyst is the size of a small orange. Its inner
surface is smooth, glistening, and shows the remains of dissepi-
ments which have gradually given way, the growth having been
at first evidently multilocular. Scattered over the surface are
innumerable minute simple cysts, some also as large as a pea ;
a few are found more deeply situated in the kidney-substance.

76. V ery advanced cystic degeneration of the kidneys. Both organs

are thickly studded with cysts, varying in size from a
mustard-seed to a hazelnut, and a larger one (the size of a
small orange) projects from the lower extremity of the right
kidney. This kidney is preserved entire. The left kidney,
bisected, exhibits similar small cysts occupying both the cortical
and pyramidal structures. The latter is reduced, yellowish-
white in colour, firm, and tough. The surface of the kidney is
lobulatcd and slightly granular ; the capsule adherent. All the
cysts contain clear, transparent, serous fluid. Taken from a native
female who died in hospital of dysentery.

77. lti'dit kidney with two large and several smaller cysts. One,

situated near the superior extremity, is seen, on section, to be
multilocular ; it is as large as a nutmeg, and illustrates well the
usual mode of formation of the larger renal cysts, — viz. by
the coalescence of two or more small cysts, their intervening
dissepiments giving way.

sebies XI.] CYSTIC DEGENERATION OF KIDNEYS.

401

78. Kidneys far advanced in cystic degeneration. — From an East

Indian female, aged 80, who died of chronic diarrhoea. One
kidney is laid open, and the capsule removed. In the other, the
capsule has been left in situ, and the renal cysts are seen through
it. They vary in size from a walnut to a pea, and contain clear,
amber-coloured, serous fluid. In the right kidney (opened) the
pelvis and calyces are seen to be much expanded, and the proper
secreting-structure proportionately atrophied.

79. Kidneys— the right incised, the left entire. Both exhibit much

contraction and atrophy of the secreting-structure and cystic
transformation. The cysts in the left kidney are very large.
Two of these — one on the anterior aspect, the other at the
inferior extremity — are respectively as large as a walnut and
a pigeon’s egg. They all contain clear — almost colourless —
limpid fluid. — From an East Indian female, aged 96, who died
of senile exhaustion and diarrhoea. (“ Medical Post-mortem
Records,” vol. I, 1876, pp. 965-66.)

80. A ery extensive cystic degeneration of both kidneys. Both organs
are much enlarged, — especially the right kidney. The conform-
ation of the latter is so altered by the cystic change that it looks
more like a mass of hydatids than a kidney. The left is less
affected, and has been divided in order to show the great
wasting of the secreting-structure. The cysts in these organs
vary in size from a pea to a small orange,— the largest in the left
kidney, they contain either clear, amber- coloured, serous fluid,
or (a few) more opaque, curdy or cheesy-looking material. The
larger cysts have evidently been formed by the coalescence of two
or more small ones, as may readily be observed in the incised
kidney,— the remnants of broken down dissepiments being still
visible. I hey affect chiefly, but not exclusively, the cortical
structure. — From a native woman, aged about 45, who died of
cerebral apoplexy. ( Presented by the Police Surgeon.)

81. Kidneys horn a case of chronic Bright’s disease — a native male,

aged 45, — showing a markedly granular condition, and the
presence of innumerable small cysts, thickly distributed over
both Die surfaces and in the deeper renal parenchyma. They
vary in size from a pin’s head to a pea, and contain either thin
serous fluid, or thick glue-like colloid material.

82. The left kidney of a, native adult, showing a cyst the size of a

large orange, with thin, semi-transparent walls, and containing
c ear, limpid, serous fluid. It has developed, at the expense of
the secreting-structure, from the lower half of the posterior
margin and inner surface of the organ, but does not communi-
cate with the pelvis. No history. ( Presented bu the Police
ourgeon.)

83. Right kidney presenting, just beneath the capsule, a cyst with

thm, almost transparent, walls, about the size of a cricket-ball
and occupying about the middle three-fifths of the convex border
of the organ. The cyst has not been opened. Its contents
appear to be thin and serous. There are, in addition, several
smaii mucoid cysts scattered, here and there, irregularly over the

402

PYELITIS.

[series XI.

surface of the kidney, the parenchyma of which is proportionately
atrophied, but, together with the cysts, the whole kidney weighs
no less than 14 ounces. Taken from a native male (Mahomedan),
who was brought to the hospital in a moribund condition,
apparently from great debility and semi-starvation after an attack
of intermittent fever, and who died within an hour of admission.

84. A similar specimen. The right kidney with a cyst about the
size of a cricket-ball. It has thin transparent walls, formed in
part by the expanded capsule of the organ, and its contents
are clear, limpid, and serous. It occupies the lower half of the
kidney. — From a native male, aged 35, who died of dysentery.

85. “ A very beautiful preparation, showing enormous dilatation of the

pelvis and ureters from obstruction, caused by an oval calculus,
which is seen quite filling up the cavity of the thickened, con-
tracted, and hypertrophied bladder.” Both ureters are greatly
dilated and varicose. “ The whole of the medullary and cortical
substance of the left kidney has been destroyed, the organ pre-
senting a huge pelvis, with many sacculations replacing the true
parenchyma. The secreting portion of the right kidney is hyper-
trophied ; but the increasing size of the pelvis has begun to pro-
mote the destruction of the adjacent medullary substance. The
parieties of the bladder vary in thickness from a half to three-
quarters of an inch.” (Ewart.)

86. A preparation showing two kidneys joined at their inferior extremi-

ties by a firm, rounded band of partly glandular, partly fibrous
tissue, an inch and a half in length, three-fourths of an inch in
thickness. These organs show great dilatation of their pelvis
and calyces, while the proper secreting-structure is reduced and
atrophied. Occupying the pelvis of the right kidney is an ir-
regular-shaped mulberry-looking dark, surfaced calculus, and, in
that of the left, a large rounded lithic acid calculus. The ureters
from these conjoined kidneys are much dilated, and their Avails
thickened. — From a prisoner in the Rawulpindi Jail. ( Presented
by Dr, R. T. Lyons.)

87- “ Both kidneys of a European patient, aged 28, who was admitted

with fever and pain in the left side, and whose urine was foetid
and contained casts. On the 14th day after admission he was
attacked with severe abdominal pain, and died, collapsed, in a
couple of hours.

“A large abscess, holding two pints of pus, Occupied the left
lumbar region. It was bounded above by the pancreas, in front
by the transverse colon, descending layer of transverse meso-colon,
and left kidney. Externally it was bounded by the left kidney
and circumrenal adipose tissue, internally by the aorta, and
posteriorly by the psoas muscle, loAver ribs, and costal origin of
the diaphragm, a portion of which was destroyed, so as to expose
the tenth rib.

« The left kidney shows great dilatation of the pelvis, ureter, in-
fundibula, and calyces. There is a ragged opening in the posterior
wall of the pelvis, through which a plug-shaped calculus, about
the size of a grape, is seen protruding. At the autopsy, the

SERIES XI. J

PYELITIS.

403

calculus had completely escaped from the pelvis, and was lying
loose in the cavity of the abscess. Two small calculi, the size of
mustard-seeds, were also found in the dilated calyces. The ureter
(in which a glass tube has been placed) is considerably dilated.
The kidney was imbedded in dense adipose tissue, which was so
adherent to its capsule as to render its removal very difficult.

“ The right kidney is healthy, but hypertrophied to compensate
for the loss of the left.” (Colles.) (. Presented by Professor
Chuckerbutty.)

88. The left kidney of a Mahomedan, aged 30, who died in hospital of

remittent fever. The whole organ,— as is seen in the section
made, — is hollowed out into a series of ampullar or cystic dila-
tations, expansions of the normal calyces and pelvis of the
kidney. These have encroached upon and produced great
atrophy of the proper secreting-structure, so that in parts it is
not more than a quarter of an inch in thickness.

89. The kidneys, with the ureters and bladder, of a European patient

in the General Hospital, who died after the operation of litho-
tomy.

This preparation exhibits, very markedly, the effects of acute pyelo-
nephritis, the result of chronic irritability of the urinary bladder
(cystitis) from the presence of a calculus. The kidneys are
enormously enlarged and swollen. In the fresh state they were
intensely vascular and injected, — numerous purplish blotchings
and puneta of blood extravasation being freely distributed
throughout both cortical and medullary portions of the renal
parenchyma. The pelvis in each organ is remarkably dilated, as
also are the calyces ; and their lining membrane highly injected
and ecchymosed. Both ureters are considerably expanded, and
their lining membrane intensely congested and softened. The
urinary bladder is contracted, and all its coats, but especially the
muscular, hypertrophied. ( Presented by Dr. D. O’C. Raye.)

90. L eft kidney, with an impacted calculus in the pelvis. It is irreg-
ular in shape, and apparently of the mulberry (oxalate of lime)
variety. The calyces, pelvis, and ureter are much dilated, and
were occupied by purulent fluid. The secreting-structure is
acutely inflamed and reduced in thickness (acute pyelitis). — From
a native male, aged 60, who died from fracture of the skull.
( Presented by the Police Surgeon.)

91. “ Left kidney of a Sonthal, aged 32, who died in the Hazaribagli Jail

of diarrhoea, and strumous abscesses in different parts of the
body. He had complained of pain down the left loin and thigh
for some years, but was able to do light work until three months
of his death. The pelvis, infundibula, and calyces form a
sacculated cyst, whose walls (with which the capsule of the
kidney has coalesced) are not above a line thick, and show no
trace of glandular tissue. In one of the saccules lay two
calculi, the size of pins’ heads. The ureter, at about an inch
from the pelvis, was occluded by a conical calculus, as large as a
kidney-bean. The right kidney was enlarged but healthy ; and

404 HYDRONEPHROSIS. [series xi.

there were no calculi in the bladder.” (Colles.) ( Presented by

Dr. J. M. Coates, Superintendent, Hazaribagh Jail.)

92. Pyo -nephritis. The right kidney of a Hindu (male) patient,

aged 45, in a state of suppurative disorganisation. The section
made through it shows extensive dilatation of the pelvis and
calyces, with the impaction, in one of the latter, of an irregular-
shaped “ mulberry” calculus, about the size of a bullet. The
proper secreting structure has almost disappeared. The organ
is made up of a series of cysts or pouches, which were filled
with purulent fluid, and are separated from each other by broad
bridges of fibro-cellular tissue.

93. Hydronephrosis of the left kidney. From a native male (Hindu),

aged 32, who died of abscess of the liver. On post-mortem
examination this left kidney was found collapsed and empty,
lying against the spine in the left lumbar region. It consists
simply of three large and two or three smaller intercommuni-
cating pouches. The secreting or grandular structure has
entirely disappeared. The three larger pouches open into a
much dilated pelvis, from which proceeds a very narrow but
pervious ureter. The opposite kidney was large and hyper-
trophied (compensatory).

94. An enormous hydronephrotic tumour, from an East Indian (male),

aged 35, who died of pulmonary phthisis. On opening
the abdomen, post-mortem , this tumour, — the size of

a cocoanut,— was found occupying the left lumbar, left
hypochondriac, a portion of the epigastric, and the umbilical
regions. It consisted (as may be seen in the preparation) of
two parts. — That which lay nearest and a little across the
median line, is oval in shape, and resembles a greatly distended
gall-bladder ; the other and larger part is about the size of the
foetal head. There is an hour-glass-like constriction between
these two portions. This tumour was bounded superiorly by the
stomach, below by the intestines, in front by the mesentery,
behind by the spinal column and spleen, to the right by the
liver, and to the left by the left kidney — with which it is inti-
mately connected. It consists of an enormous cyst, filled
with clear, limpid fluid. It was developed from the whole of
one lateral half (the right) of the kidney. The latter is
atrophied, and its substance studded with small serous cysts.
The pelvis is large, and encroaches upon the secreting-structure.
The ureter is free, and does not communicate with the huge cyst
above described.

95. Left kidney showing great expansion of the pelvis and calyces,

so as to form several rounded loculi and cystic dilatations. There
is atrophy of the secreting structure. Taken from a native
male patient, aged 21, who had long suffered from stricture of
the urethra, and who died after the operation of perinseal section.
( See further. “Surgical Post-mortem Records,” vol. I, 1875, pp.
183-84.)

SEBIES XI.]

CALCULUS IN KIDNEY.

405

96. “A kidney, in the parenchyma of which several calculi are imbedded.”

They appear to be firmly encysted, are of irregular outline,
tuberculated, and of a brownish-yellow colour.

97. “ Sections of both kidneys. The left kidney presents a large

calculus, very irregular and much nodulated, occupying the
pelvis, and sending nodular projections into the calyces. There
are also exhibited two calculi, occupying a considerable portion
of the medullary and cortical structure. The organ is so
much taken up with calculi and sacculated pouches that
there is only a thin layer of the cortical structure remain-
ing. The right kidney is reduced in size, is much sacculated,
and exhibits one small calculus.” (Ewart.) ( Presented by
Assistant-Surgeon Tameez Khan.)

98. Small and atrophied kidneys, with great dilatation of the ureters,
pelvis, and calyces, from the impaction of calculi. In the prep-
aration, a large irregular-shaped calculus is seen completely
filling the pelvis of the upper kidney, and sending prolongations
into the calyces. In the lower kidney a group of about half a
dozen small calculi obstruct the ureter. The secreting structure
in both organs is much reduced, and the renal parenchyma greatly
sacculated. ( Presented by Professor Edward Goodeve.)

99. “ Eight kidney, with pelvis and infundibula greatly dilated, and

occupied by an irregular-shaped calculus, which has broken into
several fragments.” (Colics.) ( Presented by Dr. D. B. Smith.)

100. Left kidney of a native male patient, aged 34, who died of
hydrophobia. The organ, on section, shows great dilatation of
the pelvis, with the formation of sacculi or diverticula, and corre-
sponding atrophy of the secreting structure. Impacted firmly
at the lower part of the pelvis is a very irregular-shaped (“ mul-
berry”) calculus, and filling several of the infundibula are
numerous small facetted calculi (lithic acid), about the size of
tapioca-grains.

101. Atrophied right kidney, showing also, a large, dark-looking, prob-
ably lithic acid calculus filling the dilated pelvis, and sending
processes into the infundibula. The left kidney, also preserved,
is hypertrophied.

“ It is said that the man, (a native male, aged 30), suffered from severe
pain in the abdomen, and committed suicide by hanging.” {Pre-
sented by Uday Chand Dutt, Civil Medical Officer, Furreedpore.)

102. Kidneys with large haemorrhagic infarctions. The largest is
situated at the lower extremity of the left kidney, has an area
of about two square inches at the surface, but is wedge-shaped,
and becomes narrowed as it extends more deeply into the
kidney-substance. The others are smaller, stand out abruptly
from the renal surface, and are distinctly circumscribed. They
all appear to be of recent origin, and presented (in the fresh
state) a smooth, homogeneous, dark-purple colour. Small
haemorrhagic puncta or ecchymoses were freely distributed
throughout the deeper parenchyma of both organs.

400

TUBERCLE OF THE KIDNEY.

[series XI.

From a native male (Mahomedan), aged 40, who died of cerebral
apoplexy. ( See further, “ Medical Post-mortem Records,”

vol. Ill, 1880, pp. G03-4.)

103. The kidneys of a European woman, aged 30, a prostitute,
admitted into hospital suffering from phthisis. She was attacked
somewhat suddenly with uraemic symptoms (convulsions, &c.)
and died, comatose, in a few hours.

Both organs are much enlarged, swollen, soft, and highly vascular.
The right weighs 10 and the left 7 ounces. The surface of
the right kidney, just beneath the capsule, presents several large
recent haemorrhagic infarctions. The largest measures two
inches in length, an inch in breadth, and occupies nearly the
whole thickness of the renal parenchyma. Others have a
superficial area varying from about that of a rupee to that of a
split-pea. They are all strictly and abruptly circumscribed,
more or less wedge-shaped, dark-red in colour, and homogeneous
in appearance. Besides these, there are innumerable small circum-
scribed abscesses and points of incipient suppuration ; while the
renal parenchyma generally is softened and intensely vascular.
In the left kidney these changes are not so marked, but there
are numerous small infarctions, — some recent, others decolourised ;
some softening, others absolutely purulent,— all freely dis-
tributed over the surface, and also in the substance of the organ,
the general parenchyma of which is, as in the right kidney,
highly congested and of a dark-purplish colour. (“ Medical Post-
mortem Records,” vol. Ill, 1870, pp. 167-68.)

104. “ Sections of two kidneys, showing large localized strumous
deposits, some of which are more or less degenerated and
softened. In those parts where they are situated, they have led
to the complete destruction of all the renal structure. Thus
the deposits of opaque-yellow tubercular material are well defined
and circumscribed. Those undergoing softening and liquefaction
appear as if they were encysted. These depositions are almost
wholly confined to the cortical portions of the organs. From a
Mulatto male, who had twice been operated upon for stone, and
died, anasarcous, with albuminuria.” (Ewart.) ( Presented by
Professor Norman Chevers.)

105 Kidneys from a case of acute general tuberculosis, — an East
Indian male, aged 35. Both organs are enlarged and flabby, and
are seen to be diffusely infiltrated with yellowish-white tubercles,
about the size of duck-shot. These are most abundant at the
surface, just beneath the capsule, and more numerous in the
cortical than in the pyramidal structure. The lungs and spleen
were found similarly affected.

106. Both kidneys affected with “ scrofulous disease ” or “ renal
phthisis,” — a magnificent example of a somewhat rare morbid
condition. Both organs are enlarged to about three times their
natural size, and proportionately increased in weight. The
capsules are thickened and morbidly adherent. When stripped
forcibly, the surface of each kidney presents a lobulated or tuber-
culated condition — smooth, flattened patches of the parenchyma

SEEIES XI.]

RENAL PHTHISIS.

407

alternating with projecting, more or less rounded, soft nodules.
On section, the pelvis and calyces of each organ are seen to be
greatly thickened, and their lining membrane dotted over with
soft tubercular patches or granules, or small superficial erosions.
The whole of the secreting structure — specially in the left kidney —
is occupied by rounded, softening masses of yellowish-white colour,
and of cheesy appearance and consistency. These vary in size
from that of a walnut to that of a pea, or smaller the larger
ones evidently formed by the coalescence of two or more smaller
' nodules. The central portions of these masses are very soft
indeed, like cream, and consist of a puriform debris , which, under
the microscope, reveals a large quantity of granular and mole-
cular fat, with yellowish pigment-matter, and degenerating free
nuclei and cells, but no true formed or perfect pus corpuscles, —
changes evidently indicative of a molecular disorganisation of the
secreting structure comprised within the area of each scrofulous
mass.

Sections taken from the margins of such nodules exhibit the proper renal structure
profoundly affected — the epithelia swollen, granular, shreddy, and proliferating
within the tubules, which are dilated, distorted, many ruptured, — in parts,
denuded and quite empty. Around the tubules— i.e., in the intertubular
connective tissue — there is an abundant free cell-growth in parts (not uni-
formly). The cells are small, granular, and nucleated. In parts again, this
kind of small-celled proliferation is combined with overgrowth of the
delicate connective tissue itself, forming limited areas in which either
no secreting structure exists, or but the faint outlines of tubules and
Malpighian bodies can be discovered. On the whole, the characters of what
is recognised as “ renal phthisis ” or “ scrofulous disease " of the kidneys is
well displayed in both these organs.

| The patient, a European (adult), died in the Presidency General
Hospital.

“ He had been ill for two years, getting by degrees thinner and weaker. For some
time past has noticed that his urine has been thick when passed, and little
curdy masses have come away. Has never had any pain or difficulty in passing
urine, and has never passed blood. There was a little fulness in the left lumbar
region, and marked tenderness on pressure there. The urine was very
slightly acid, full of albumen and pus-cells. On post-mortem examination, the
lungs were collapsed, — (the left apex had a scar in it) — they were anamiic and
crepitant. The walls of the left ventricle of the heart were very thin.
The liver showed no marked change, except thickening of the capsule in
places. Brain and intestines not examined.” (Note by Dr. Wall.)

! Presented by Dr. J. C. Wall, General Hospital, Calcutta.

1107. A very remarkably nodulated and fissured condition of the kidneys,
irregularly distributed, — i.e., not uniform in either organ. The
surfaces also exhibit numerous small cysts, varying in size from
a hazelnut to a sago-grain. Many minute cysts occupy the
deeper renal parenchyma, — particularly the cortical portion.
The appearances of these organs suggested syphilitic changes,
and this is confirmed on microscopic examination.

The entire cortex is found infiltrated, at intervals, and in an irregular manner, with
a small-celled, nuclear growth, tending in parts to imperfect fibrillation,
in others to granular, fatty, and mucoid degeneration. The secreting

408

SARCOMA OP THE KIDNEY.

[series XI.

structure is much destroyed. The Malpighian capsules are dilated to form
cysts, — some of which are of large size, and have imperfect dissepiments.
The tubules are either empty or filled with highly granular epithelium,
and some contain colloid or mucoid casts.

From a West Indian (Negro), aged 40, who died in hospital of pulmonary
phthisis. (“ Medical Post-mortem Records, ” vol. Ill, 1879,
pp. 359-00.)

108. Right kidney, from a case of diffuse melanosis, — an East Indian
(male), aged 44, — showing small, dark, sooty deposits in the
cellular tissue and lymph-glands surrounding the pelvis and
capsule of the organ. I he substance of the kidney is apparently
not involved.

The structure of these melanotic deposits is that of enkephaloid carci-
noma. The liver, brain, bones, &c., were infiltrated with similar
growths. (“ Medical Post-mortem Records,” vol. I, p. 16.)

109. Sarcoma of the kidney. Left kidney of a native male, aged 35.
“ The man had been recently admitted in a dying state, suffer-
ing from dysentery, and with an iliac abscess on the left side.
The latter was opened. It contained a quantity of semi-
solid pus. On 'post-mortem examination the left kidney was found
totally disorganised. The iliac abscess was isolated and had no
connection with the kidney.” The kidney is enormously enlarg-
ed,— weighs 24 ounces, and was with difficulty separable on the
inner side from a group of enlarged mesenteric andlumbar glands.
The capsule is much thickened and adherent to the surface of the
organ. At the hilum, the ureter and renal blood-vessels are
found inseparably matted together, and imbedded in a dense
lobulated mass of enlarged lymphatic glands and infiltrated
connective tissue. The secreting-structure (as may be seen
from the section made) is greatly atrophied, or rather, completely
disorganised, as regards the inner two-thirds of the organ ; a
thickened rim of renal tissue, measuring about half an inch in
diameter, only persists at the periphery of the kidney. The
disorganised portion is soft and pulpy, of a brownish or pale-
yellowish colour.

Microscopically examined, it exhibits a few renal vessels and tubules, — the latter
destitute of epithelial lining, and much broken up. Taking the place of the
disintegrated secreting structure is a highly cellular lymphoid growth.
The cells have single large nuclei, and are imbedded in a scanty fibrillated
stroma, the nnshes of which are so small as to be only visible in well-
brushed-out sections. The lymphatic glands — lumbar and mesenteric — (not
preserved), showed similar changes. The growth, therefore, appears to be a
lympho-sarcoma or lymphadenoma. (P resented by Dr. D. O’C. Raye,
Presidency General Hospital.)

Small horse-shoe shaped kidney from a youth. No history.
Large horse-shoe kidney. There is a thick isthmus joining the
lateral halves. It is deeply grooved on the anterior aspect, and
within the grooves lie the ureters (two). ( Presented by Dr. J.
Macpherson.)

Horse-shoe shaped kidney. The double ureter descends on the
anterior surface of the “ isthmus,” lying in shallow grooves here.

no.

in.

112.

seeies xi.] MALFORMATIONS OF THE KIDNEY.

409

The aorta ancl vena cava are seen in situ. From the former,
which lies in a deep groove behind the isthmus, three renal
arteries are given off. Two large renal veins from the right, and
* one from the left half of the organ enter the inferior vena
cava on the anterior aspect of the kidney. ( Presented by Assist-
ant-Surgeon Juggabandu Bose.)

113. “ A specimen of horse-shoe shaped kidney, from a case of hepatic
abscess.”

The lateral halves of the organ are united at their lower ends
by a transverse band two inches long, an inch and a half
broad, and an inch thick. On its anterior surface descend the
ureters, lying in longitudinal well-marked grooves. A common
capsule invests the whole organ ; it separates easily, and appears
to he healthy. The left is the larger half of the kidney, measures
5^ inches X 2| inches. The right measures 5 inches x
2| inches. The transverse or connecting portion is directly

continuous with the secreting or glandular structure of the
lateral halves of this kidney, and exhibits, under the microscope,
an exactly similar structure— straight and convoluted uriniferous
tubules, Malpighian capsules, blood-vessels, &c. ( Presented by

Dr. Joubert, Presidency General Hospital.)

114. A conjoined kidney, from a case of cholera, a native male,
aged 25. The organ is horse-shoe shaped, with the convexity
directed downards. The connecting portion (isthmus) is about
an inch in length and the same in thickness. It rested on the
first lumbar vertebra. It is enclosed in a common capsule with
the lateral halves of the organ. The ureters (double) pass
downwards and inwards, cross the anterior surface of the
isthmus, lying in distinctly marked grooves here, and proceed
to the urinary bladder (also preserved), where they terminate in
the usual manner.

115. Single horse-shoe shaped kidney. The lateral portions are
united by a narrow band or isthmus, which rested on the second
lumbar vertebra. The anterior surface of the latter is marked
by two slight, shallow grooves for the reception of the ureters
(double), which pass downwards and outwards to the base of the
bladder {see preparation).

Found on post-mortem examination of a native male (Hindu), aged 35,
who died in hospital from aneurism of the thoracic aorta.

116. Another similar specimen, from a dissecting-room subject, a
native male, aged 35. The commissure lay over the third lumbar
vertebra, the aorta and vena cava intervening between it and
the spine. On the anterior surface of the commissure or isthmus
are two distinct grooves, in which were lodged the respective
ureters of each lateral half of this kidney. ( Presented bu
Mr. T. G. Palit.)

117. Kidneys with ureters and urinary bladder, preserved together
to show their mutual relationship. The left kidney is misplaced.
It is somewhat small in size, but otherwise normal. It was

410

MISPLACEMENT OP THE KIDNEY. [series xi.

found at the brim of the pelvis, immediately over the left sacro-
iliac synchondrosis, above, and a little to the outer side of the
left common iliac vessels. The arterial supply is derived from
the aorta low down,— two branches (one of which has been
accidentally cut through) given off just above its bifurcation
( see preparation). The left ureter measures only four inches.
It passed along the left side of the cavity of the pelvis, anl
terminated in the urinary bladder in the usual manner. — From a
native male, aged 25.

118. A misplaced kidney (the right), found on 'post-mortem examin-
ation of an aged Armenian (male) , who died from scirrhus carcinoma
of the liver.

This kidney was found lying immediately over the prominence of the
sacrum, at the brim of the pelvis. There are two renal arteries
( see preparation), given off from the abdominal aorta, half an
inch above its bifurcation, and both arise from its anterior
aspect. The one to the left passes directly downwards to the
apex of the kidney, and there breaks up. The right branch is
larger, and proceeds to the hilum. The renal veins are four or
five in number. The largest, emerging from the kidney, is
directed upwards and to the left, and joins the left renal vein.
Two others cross the anterior surface to reach the inferior
vena cava, and one or two small veins join the left common
iliac.

The ureter of this kidney is short, and descended almost vertically to
the base of the bladder. The left kidney occupied its normal
position.

119. Misplaced kidney (left). It was found at the brim of the pelvis,
over the left sacro-iliac articulation. The hilum is directed
towards the left, and from it the ureter descends to the bladder.
It is short and throughout dilated. The right kidney occupied
its normal position. From a European (male), aged 40, who
died of cerebral apoplexy. ( See further, “ Medical Post-mortem
Kecords,” vol. Ill, 1880, pp. 693-94.)

120. Large single or solitary kidney, weighing 11| ounces. “No right
kidney was found ; this is the left one, and communicated by
means of a single ureter with the urinary bladder.” The organ
is enlarged, but its structure, both to the naked eye and on
microscopic examination, appears to be healthy. The surfaces
are somewhat unusually lobulated (congenital), but smooth ; the
capsule separated easily. Both cortical and pyramidal portions
of the secreting structure participate, about equally, in the hyper-
trophy.

‘ From a European (Italian), who died in hospital from syphilis and
puimonary phthisis.” {Presented by Professor J. Fayrer.)

121. “ Left kidney of a female, from the dissecting-room, showing two
ureters, which, however, are seen uniting into one before they
reach the bladder.” {Presented by Professor Crozier.)

series xi.] DISEASES OF THE URETERS. 411

122. Right kidney with two ureters, each of about equal size. They
emerge from the upper and lower ends, respectively, of the
hilum, and remain separate for about six inches, then unite to
form a common duct, which opened into the bladder in the
usual manner. ( Presented by Dr. D. E. Smith.)

123. The right kidney and ureter of a native male (Hindu), aged
about 40, who died of pelvic peritonitis, after the operation of
lithotomy. The secreting structure of the kidney is seen to be
much wasted, and the pelvis, calyces, and ureter dilated,— the
last (ureter) especially so ; it presents a moniliform appearance
from this cause. Impacted in its canal, about an inch above
its vesical termination, is an oval-shaped calculus, about the
size of a sparrow’s egg. ( See further, “ Surgical Post-mortem
Records,” vol. I, 1875, pp. 203-4.)

124. The kidneys, ureters, and urinary bladder of a native male infant,
aged four months. The kidneys are “ reduced to mere sacs,”
the secreting structure has almost entirely disappeared. The
ureters are enormously dilated, especially about an inch above
their vesical terminations. They were found distended with a
“ limpid, odourless fluid.” The bladder is “ hypertrophied, its
£oats being much thickened ; the muscular fasciculi enormously
enlarged, and crossing one another in every direction, giving the
interior of the viscus the appearance of a ventricle of the heart.”
There is a prominent and enlarged condition of the “ uvula ” or
fold of mucous membrane at the neck of the bladder, which pro-
jects into the prostatic portion of the urethra, and probably was
the cause of the retention of urine, from which the child suffered,
aud has led to the abnormal condition of the ureters and kidneys
above described.

The infant suffered from constant sickness, probably due to uraemic
poisoning, and died comatose.

“ There was not a trace of inflammatory action in the bladder, ureters
or kidneys,” and the urethra was healthy throughout. (Case
fully reported in Indian Medical Gazette , vol. XII, 1877,
p. 244.) ( Presented by Surgeon-Major F. Odevaine, e.k.c.s.,

Bhopal Battalion.)

125. The left kidney of a native male (Hindu), aged 47, who died of
exhaustion and pyo -nephritis after the operation of lithotomy.
The secreting structure of the kidney is seen to be greatly wasted,
while the pelvis and calyces are enormously dilated, and form
a cavity the size of an orange. This was found filled with puru-
lent fluid.

About two inches from the pelvis, the ureter is seen to be obstructed by
a conical-shaped calculus, the size of a bullet, — its flattened base,
being directed towards the kidney, the apex downwards. It has
evidently become impacted on its way to the bladder. The right
kidney also showed considerable dilatation and inflammation of
the pelvis, and atrophy of the secreting structure.

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PART YXI.

INJURIES AND DISEASES OF THE BLADDER,
URETHRA, AND PROSTATE GLAND.

INJURIES AND DISEASES OF THE MALE
ORGANS OF GENERATION.

i INJURIES AND DISEASES OF THE FEMALE
ORGANS OF GENERATION.

Series XII, XIII, and XIV.

SERIES XII.]

INDEX.

415

Series XII.

INJURIES AND DISEASES OF THE BLADDER,
URETHRA, AND PROSTATE GLAND.

INDEX TO THE SERIES.

A. -THE BLADDER— \> ,

'VO.- ,

1. — Rupture, 1,2. ' :

2. — Hypertrophy, 3, 4, 5, 6, 7, 8, 12, 13, 14, 16, 24, 35, 89, 40, 45.

3. — Ateophy, 9, 29, 38.

4. — Acute cystitis, 10, 11, 34.

5. — Chronic cystitis, 12, 13, 16, 22, 50.

C. — Abscess, 14.

7. — Ulceration, 10, 15, 51.

8. — Sacculation, 16, 31.

9. — Fistula, 17, 18, 19, 20.

10. — Calculi in, 21, 22, 30.

11. — Effects oe eesults of lithotomy, 23, 24, 25, 26, 27, 28, 53,

12. — „ „ „ „ lithoteity, 29, 30, 31.

B. -T1IE URETHRA—

1— Recto-ueethral fistula, 32, 33.

2. — Strictueb : —

(a) At the orifice, 13, 34, 35.

(b) Near the meatus, 3, 35, 36.

(r) In the spongy portion, 34, 40, 41.

(d) In the bulbous portion, 12, 14, 23, 37, 38, 39, 40, 41, 42.

( e ) In the membranous portion, 6, 7, 8, 43, 44, 45.

3. — Dilatation of, behind steictube, 3, 7, 37, 39, 41, 45.

4. — Abscess and fistula in peeineo, 33, 34.

5. — False passages, 6, 7, 13, 14, 15, 33, 39, 40, 41, 42, 45, 46, 47.

6 — Results of peeineal section, 14, 33, 34, 39,44.

7. — Impaction of calculus, 48.

8. — Illustbations of extravasation of urine, 1, 31, 35, 36, 39, 40, 47.

416

HYPERTROPHY OF THE BLADDER.

[series XII.

C. — THE PROSTATE—

1. — Chronic enlargement, 29, 49, 50, 51, 52, 53.

2. — Abscess, 13, 38, 54.

3. — Perforation by instruments, 39, 41, 52, 53.

4. — Corpora amylacea in, 51.

D. -THE FEMALE BLADDER—

1. — Slough, 55.

2. — Laceration in operation of ovariotomy, 56.

1. “ Bladder, pubis, scrotum, and penis in situ. The bladder is rup-

tured in two places, one aperture being in front and to the left,
the other being near the fundus and at the right side. The
latter is as large as a florin, as held open by a glass rod, and
possessing somewhat uneven margins. The former is as large as
a sixpence, but there is a prolongation of mucous membrane,
partially shutting up and limiting the size of the aperture.
— From a European who fell out of a window while in a state of
intoxication. Urine had extravasated into the cavity of the
abdomen. None passed without the use of the catheter, which
passed through the rent into the abdominal cavity. The
intestines were agglutinated together from peritonitis. Patient
died on the fourth day after the accident.” (Ewart.)

Presented by Professor R. O’Shaughnessv.

2. “ Rupture of the anterior portion of the bladder in a female. The

edges of the breach are rendered rough and irregular by the
deposition of lymph. That part of the margin which is smooth
and even has been produced by the knife after death. The
uterus, ovaries, and vagina, are in situ.” (Ewart.) No history.

3. Hypertrophy of the bladder. “The muscular structure of the

bladder is now * of an inch thick, from stricture about a couple
of inches from the meatus urinarius externus. The mucous
membrane and connective tissue are increased in bulk. There
is great thickening and dilatation of the urethra behind the
stricture. The sacculation at the membranous portion has given
way, and become disorganized from sloughing inflammation. It
now presents shreds of perished and perishing connective and mus-
cular tissues. The mucous membrane of the bladder is thickened,
dull, opaque, and more or less lined by shreds of exudation material.
There is a considerable quantity of fibrous tissue at the seat of
stricture, and for some distance anteriorly and posteriorly. The
adjacent corpora cavernosa are condensed and hypertrophied.”
(Ewart.) Presented by Dr. Dickenson of Azimghur.

4. “ Bladder and penis, with the urethral canal and vesical cavity laid

open. The viseus is greatly contracted, and its walls are
enormously thickened. The rugae and sulci, caused by irregular-
ities in the increased growth of the subjacent muscular fasciculi,

series xii.] ACUTE CYSTITIS. 417

are well marked. The prostate is enlarged, and the correspond-
ing portion of the urethra dilated. From stricture of the
urethra.” (Ewart.)

5. A specimen exhibiting enormous concentric hypertrophy of the

bladder,— the muscular coat being chiefly affected. It is thrown
into huge, irregular folds, and measures fully three-quarters of an
inch in thickness. The capacity of the bladder is greatly
reduced. No history.

6. Hypertrophy of the bladder, particularly of the muscular coat, the

result of stricture of the urethra. There are several false
passages in the membrano-prostatic portion of the canal. — “ From
a European seaman, aged 34, who died of cholera.”

7. The bladder and urethra of a European, aged 61, who died in

hospital. The bladder is enormously enlarged, and its. coats
greatly hypertrophied. The mucous membrane— in the recent
state — was a good deal congested, and thrown into prominent
vascular folds. There is an old organic stricture in the mem-
branous portion of the urethra, while the prostatic portion
is dilated and riddled with false passages.

Presented by Professor J. Fayrer.

8. Hypertrophy of the bladder from stricture of the urethra. “ The

patient had had a tight stricture for many years. This occasionally
so increased by spasm that for weeks the bladder remained full
and distended, the urine merely dribbling away. He was admitted
into the General Hospital in this condition, complicated by
* Chittagong fever ’ of several weeks’ duration. The stricture was
overcome by passing Nos. 8, 10, and 12 catheters on three con-
secutive days under chloroform, but this was too late to save
life ; anaimia and malarious fever causing death.” The stricture
is situated in the membranous portion of the urethra, where
there is much fibrous thickening of the submucous tissues.
Presented by Dr. W. J. Palmer, Presidency General Hospital.

9. Atrophy of the bladder. All the coats of the viscus are much

thinned and dissected-out looking. The lateral lobes of the
prostate gland are enlarged. — From a European, aged 58, who
died of Morbus Brightii (granular and contracted kidneys).

See further, “ Medical Post-mortem Becords,” vol. Ill, 1880,
pp. 677-78.

10. “ Inflamed mucous membrane of the bladder, which has ulcerated

on its anterior aspect. These ulcers are covered with flocculent
lymph and mucus, and the rest of the surface is slightly
roughenfed by minute depositions of lymph upon an over-granu-
lated condition of the mucous membrane. The muscular coat is
thickened.” (Allan Webb, Pathologic i Inclica, No. 183, p. 210.)

11. Acute inflammation of the bladder, the mucous membrane of which

is seen thrown into prominent folds and rugae, which are ulcer-
ated and covered with recent inflammatory exudation. The

process has apparently extended upwards through the ureters

which are dilated and their lining membrane inflamed — into the
kidneys. These organs are large, highly vascular, and softened ;
their pelves and calyces are dilated and superficially ulcerated

*• ,

418 CHRONIC CYSTITIS. [series xii.

(pyelitis) ; and the renal substance, both superficially and more
deeply, is infiltrated with minute points of suppuration.

12. Chronic cystitis, the result, apparently, of stricture at the bulbous

portion of the urethra. The walls of the bladder are greatly
hypertrophied, and the mucous membrane covered, almost
uniformly, by a thin layer of recent lymph, which gives it a
remarkably rough, rugose appearance. No history.

13. The genito-urinary organs of a native male (Hindu), aged 50, who

died in hospital. The bladder is enlarged, and its walls
enormously thickened, particularly the muscular coat, which
measures from to The mucous membrane forms huge
folds or rugie, and is covered thickly by a yellowish-white
phosphatic deposit. The prostate gland is enlarged, swollen,
and soft ; the right lobe hollowed out into an abscess, which
contained about half an ounce of thick yellow pus. The
membranous and bulbous portions of the urethra present a
highly torn and disorganised condition, and the floor of this
part of the canal, for the space of about two inches, is dark and
gangrenous, and from it there are several false passages leading
down into the perineum. The urethra, anterior to this part,
shows several superficial lacerations of the mucous membrane.
The meatus is much contracted, and has a hard, cicatricial-like
appearance. It has been recently incised to permit of the
passage of a catheter.

The right kidney is a little hypertrophied ; the pelvis, calyces, and ureter
dilated. The left kidney is atrophied ; its secreting structure
reduced to a mere rim from to in thickness. The pelvis,
calyces, and ureter all much dilated. Projecting from the lower
extremity of this kidney is a thin-walled, semi-transparent cyst,
the size of a potato. ( “ Surgical Post-mortem Records ” vol. I,
1881, pp. 770-80.)

14. The urinary bladder, and urethra of a native male (Hindu), aged

25, admitted into hospital with stricture, and who died from
pyiemia following the operation of perineal section. The urinary
bladder is strongly contracted ; it is about the size of an ordinary
orange, and its walls are enormously hypertrophied. The
muscular coat alone measures at the fundus quite an inch.
The mucous lining is thickly plicated and prominent ; intensely
vascular, ecchymosed, and in parts superficially excoriated. -On
the anterior surface of the bladder, just beneath the peritoneal
coat, midway between the fundus and neck, there is a circum-
scribed abscess, involving a thickness of about a fourth of an
inch of the parieties at this part ; and half an inch lower down
is a similar, incipiently suppurating infarction, about the size of
a pea. The prostatic plexus of veins around the neck of the
bladder were found dilated, inflamed, and filled with thick pus ;
their lining membrane dark and sloughy-looking.

The prostatic and membranous portions of the urethra are riddled with
false passages, with the largest of which, a little to the left of the
median line, the opening made by the operation (perineal section)
communicates. Involving the bulbous portion of the urethra,

SEUIES XII.]

VESICAL FISTULA.

419

and extending also for about half an inch anterior to it, is a
very hard cartilaginous stricture. The urethral canal has
become almost completely obliterated at this part. ( See further,

“ Surgical Post-mortem llecords,” vol. I, 1881, pp. 769-70.)

15. The genito-urinary organs of a native male, aged 30, who died

from syphilitic myelitis with paraplegia, Ac. The urinary
bladder is in a semi-gangrenous condition. Its mucous lining
has almost entirely disappeared. The muscular coat forms
prominent ridges and furrows, is highly vascular, and super-
licially eroded or ulcerated; presents a softened, shreddy, and
disorganised appearance, especially at the neck of the bladder.

The prostatic, membranous, and bulbous portions of the urethra
exhibit numerous lacerations of the mucous membrane (false
passages), evidently produced by catheterisation. The rest of
the urethral canal is healthy.

The bladder was paralysed during life ; — the urine had to be drawn off
by catheter daily.

The kidneys are a little swollen, and were highly vascular in the fresh
state. Their surfaces are covered with small suppurating foci
(abscesses).

16. Bladder showing great thickening of the muscular coat, and a

sacculated dilatation of the wall, immediately above and to the
outer side of the orifice of the right ureter. No history.

17. “Preparation illustrating a fistula leading from the bladder

through the abdominal parieties, and communicating externally
just underneath the umbilicus. From a paraplegic native woman.
Bladder is small, with the mucous membrane at the fundus
ulcerated.” (Ewart.) Presented by Professor J. Fayrer.

18. Preparation showing ( a ) a recto-vesical fistula— indicated by a

white glass rod; the vesical orifice at the base of the trigone,
the rectal, an inch above the anus. (6) The cicatrix left in
the perineum from the operation of lateral lithotomy, performed
in this case for the removal of a calculus weighing 131 grains.
(The incision at the neck of the bladder is indicated by a blue
glass rod).

The patient, an Englishman, aged 44, had been suffering from the
fistula,— which was of “ traumatic ” origin,— for seven months.

He had nearly recovered from the operation above alluded to when
symptoms of pyaemia developed, and “ multiple abscesses in
the liver” were found after death. Presented by Professor
J. Fayrer.

19. Perforation of the urinary bladder by an abscess which had formed

between it and the rectum. “ There was no marked symptom
by which the abscess could be detected until the day before the
death of the patient, when he passed a quantity of foetid sanious
pus through the urethra.” The preparation exhibits the position
of an abscess between the rectum and the bladder, opening into
the latter below, and into the recto-vesical cul-de-sac &of the
peritoneum above. Death resulted from peritonitis.— From
a European male patient in the General Hospital, admitted for

420

CALCULUS IN THE BLADDER. [series xii.

pulmonary phthisis. Presented by Dr. D. O’C. Kaye, Presi-
dency General Hospital, Calcutta.

20. Recto-vesical fistula. The rectum and bladder are preserved as
found on post-mortem examination. The former is contracted,
its walls hypertrophied ; the mucous membrane thick and
ulcerated. A small amount of foecal matter with urine was found
in this viscus. It is firmly united to the rectum posteriorly,
and a ragged fistulous communication, nearly as large as an
eight-anna (shilling) piece, exists between them. It is situated
about four inches above the anal operature, and opens into the
fundus vesicaj. The rectum shows a swollen and softened
condition of its walls ; was adherent posteriorly to the sacrum
and coccyx, which were necrosed, and here the tissues of the
bowel are especially shreddy and disorganised. The mucous
membrane from the anus upwards as far as the sigmoid flexure
presents a series of large sloughy-looking ulcers.

History. — “ J. T. — , aged 27, an English seaman (cook), was admitted into the
General Hospital on the 30th December 1879, suffering from pain over the
sacrum, and frequent desire for defalcation. Eight weeks previously he

had received an injury over the sacrum, which was followed by severe pain

in the part, and he began to pass blood and slime. He was weak and
emaciated on admission. An ulcer, the size of a two-anna piece, was seen
with the speculum on the back wall of the rectum, about tour inches above
the anus, discharging thick pus with blood. Scanty motions with a good
deal of purulent matter continued to be passed for four weeks, and then
fceculent matter was noticed to come out by the urethra, causing much pain
and burning. Almost simultaneously two abscesses formed, one in each
iscliio-rectal fossa. These were opened, and a great deal of thick, greenish,
very offensive pus, with bubbles of gas (indicating its faecal origin), was
evacuated, and now the lower part of the sacrum and coccyx could be felt
by the finger roughened and necrosed. Thenceforth foecal matter with
urine began to pass through the openings made. The patient grew weaker;
the lower extremities became swollen and oedematous, and he died on the
10th March 1880.” Presented by Dr. F. C. Nicholson, Presidency General
Hospital, Calcutta.

21. “ Contracted bladder with hypertrophied and thickened wall,

containing an oval, triple phosphate calculus. The left ureter is
slightly dilated. The left kidney is hypertrophied its medul-
lary portion contained some incipient abscesses, and its^ capsule
peeled off: easily (it is still attached to the pelvis). The right
kidney is but half its normal size ; its glandular tissue has
almost disappeared ; and its pelvis, calyces, and infundibula are
greatly dilated (ureter wanting). — From a man of 30.” (Colies.)
Presented by Professor S. B. Partridge.

22. Bladder and kidneys of Narain Dass (Hindu), aged 40. t he

mucous membrane of the bladder is greatly thickened, and
all its coats hypertrophied. Lodged in the fundus is a
nhosphatic calculus the size of a large walnut. Both ureters
are much dilated. The left exhibits a very curious disposition
of its lining membrane into valve-like foldings, placed about two
inches apart, for the whole length from bladder to kidney. Its
channel presents corresponding alternate contractions . and
dilatations. The right ureter is also dilated, but the inner

SERIES XII.] ILLUSTRATIONS OF LITHOTOMY.

4.21

23.

24.

surface is smooth, and shows no valvular plications. The left
kidney is very extensively atrophied and disorganised. The
secreting structure is reduced to about a fourth of an inch in
thickness, and in parts has completely disappeared. The right
kidney exhibits compensatory hypertrophy, and is infiltrated,
both superficially and deeply, with numerous small abscesses.
The whole organ is in a state of acute suppurative dis-
organisation.

“ A preparation illustrating the incision in the prostate after a
fatal operation of lithotomy. The gland is shreddy and gan-
grenous around the wound. There is also seen a stricture just
in front of the bulb of the urethra, opposite to the cavity of
a small abscess. Great thickening and contraction of the
bladder.” (Ewart.) Presented by Professor J. Fayrer.

“ Thickened and contracted bladder, from a Hindu, aged 38, who
died on the eleventh day after a calculus, weighing 718 grains,
had been removed by lithotomy. The left ureter is greatly
dilated ; the left kidney atrophied. The right kidney and
ureter are of normal size.” (Colles.)

The bladder and kidney of an elderly native, operated upon for
stone. No urine was secreted from the time of the operation
to death (about 40 hours) which was associated with uraemic
symptoms.

bladder is much thickened. Its neck has been opened by a free
incision, bounded posteriorly by undivided prostate. Anteriorly
the wound reaches to the bulb, and, the stone having been a
large one (over two ounces in weight), there has been some
laceration of the parts.

“Both kidneys are slightly lobulated and smaller than natural. The
cortical portion narrow and very pale ; medullary portion desti-
tute of its usual striated appearance. There is a large cyst
(now collapsed) with thin walls in the right kidney, and several
the size of a pea in the left kidney.” (Colles.)

“ Bladder and urethra of a native operated on for stone, and
who died from fever with quasi-pysemic symptoms. No purulent
deposits were found on 'post-mortem examination, but the
kidneys were incipiently granular.

bladder and urethra are preserved to show the wound made in
lateral lithotomy. The bulb is slightly notched by the incision.”
(Colles.)

25.

The

26.

“The

' 27. A preparation preserved chiefly to illustrate the morbid anatomy
of acute pelvic cellulitis and peritonitis following the operation
of lithotomy. The surfaces of the bladder, rectum, &c., are covered
with patches of recent lymph, and the sub-peritoneal cellular
tissue presents a dark, gangrenous condition, is much softened
and swollen, and, on incision, was found infiltrated with thin
yellowish pus. The bladder is contracted ; its walls thickened.
The mucous membrane is highly vascular, inflamed, in parts
incipiently sloughy. There is much laceration of its neck,
associated with a ragged and unhealthy-looking wound in the
perineum (that of the operation). The kidneys are contracted

422 ILLUSTRATIONS OF LITHOTRITY. [sebies xii.

and highly granular. The secreting structure much wasted, *
especially in the right kidney. The pelves and calyces wide
and expanded. The right kidney has two ureters, which emerge
separately from the hilum, pass downwards, and only unite
about half an inch above the bladder, to terminate by a
single orifice in the usual position.

The patient was a Hindu, aged 40. The stone weighed a little over two ounces.
There was not much bleeding at the time of the operation. He did well
for forty-eight hours. The third day the temperature rose to 1038 ’ F,
Hiccough, vomiting, great prostration, and severe hypogastric pain soon
followed, and he died on the sixth day after the lithotomy.

( See further, “ Surgical Post-mortem Records,” vol. I, 1877,
pp. 873-74.)

28. Bladder and urethra of a native aged 40, showing the results

of a successful lateral lithotomy. The patient died from
broncho-pneumonia and catarrhal dysentery. The wound in the
perineum (indicated by a glass rod) had all but cicatrised, and
was quite healthy. ( See further, “ Surgical Post-mortem Records,”
vol. I, 1880, pp. GG7-G8.)

29. Preparation showing the effects of lithotrity upon a phos-
phatic calculus in the bladder of an old man. The stone has
been broken up into more than twenty pieces, and must have,
when entire, almost completely filled the bladder.

The walls of this viscus are thinned and contracted. The inner
surface exhibits a series of shallow depressions, suggestive of the
close application of the same upon a broadly-facetted calculus.
There is senile hypertrophy of the prostate gland.

The patient died from general peritonitis a few days after the oper-
ation.

— (Webb’s Patholoqia Indica , No. 2G8, p. 211.)

30. Urinary bladder with a calculus, the size of a walnut, superficially

crushed by the lithotrite. The external surface or crust of the
stone is opaque-white, pliosphatic, rough, and broken down at
parts ; but the main bulk of the calculus is entire, and has not
been crushed. The mucous membrane is vascular, injected, a
good deal softened. The muscular coat is hypertrophied. The
lateral lobes of the prostate are enlarged, and contained a little
purulent fluid. The patient, a native male, aged 25, died from
acute suppurative nephritis after the first attempt at lithotrity.

( See further, “ Surgical Post-mortem Records,” vol. I, 1880,
pp. G83-84.)

31. A preparation illustrating the disastrous results of lithotrity,

attempted to be performed in a small and contracted bladder,
upon a flattened, and chiefly pliosphatic calculus, which occu-
pied and was firmly imbedded in the cervical portion, where,
as may be seen in the preparation, it had formed a pouch for
itself.

The whole thickness of a portion of the posterior wall ol the bladder,
near the fundus, has been torn out, resulting in a perforation,
through which the little finger may be passed, and causing
death from extravasation of urine into the peritoneal cavit\,

SERIES XII.]

RECTO-URETHRAL FISTUL2E.

423

and consequent acute general peritonitis. (See further,
“ Surgical Post-mortem Records,” vol. I, 18S0, pp. 737-3S.)

32. Specimen showing a recto-urethral fistula, which had existed for

three years, and was the result of a wound from a piece of
pointed bamboo forcibly thrust into the bowel. “ Urine used
to flow through the rectum, and no instrument could be
passed by the urethra. Perineal section was performed, but
proved fatal.”

The bladder is seen opened anteriorly, and a glass rod has been passed
into the fistulous track between it and the rectum.

Presented by Professor S. B. Partridge.

33. Recto-urethral fistula. The rectum, bladder, and urethra of a

native male patient, aged 25. Examining the urethra, from
before backward, there is found slight thickening with con-
striction of the canal about two and a half inches from the meatus.
Half an inch beyond this are two large fistulous canals, each about
an inch and a half in length, in the lloor of the urethra, lying
parallel to each other, and having a strip of the entire thick-
ness of the canal here isolated between them. These fistula?
pass downwards and backwards into the perineum,— that on the
right for a short distance only, that on the left burrowing
deeply, and after following a circuitous route terminates in the
rectum, three inches above the anal aperture, a little to the
left of the median line. The opening here is smooth and rounded,
and looks as if produced by a catheter.

The bulbo-mombranous portion of the urethra is much torn, and scored
in various directions by false passages. Some of these lead, on
either side, into the prostate gland, and one or two burrow
beneath the mucous membrane of the neck of the bladder.

It is difficult, in the disorganised and lacerated condition of the parts,
to ascertain the exact site of the original stricture, but probably
it existed in the membranous portion of the canal. During
life tire urine passed in drops through the urethra and also per
rectum. “ On introducing a catheter it was found to deviate
towards the left side, plunging deeply between the rectum and
bladder, but could not be made to enter the latter.” Perineal
section was performed (the opening is indicated in the pre-
paration by a thin piece of talc), but the patient died with
symptoms of blood-poisoning (septicaemia) . (See further, “ Surgical
Post-mortem Records,” vol. I, 1879, pp. 589-90.)

34. Greatly hypertrophied condition of the urinary bladder, with
ulceration, superficial sloughing, great vascularity and rigidity
of its lining mucous membrane— all the results of long-standing
stricture of the urethra.

In the bulbous portion of the urethra there are two small openings
communicating with an external fistula in the perineum, and
a third in the membranous portion, a little to the left of the
median line, leading into a sinus, which also runs backwards
towards the perineum. There is no stricture in this part of the
urethra, but the meatus is much contracted, and in the spongy
portion of the canal (from two inches behind the fossa navicularis

424

STRICTURE OF TIIE URETHRA.

[series xir.

to the bulb) the walls are hard and gristly on section, and much
constricted.

Ihe patient, an Irishman, aged 51, had suffered from stricture for about four years.
\\ as twice admitted into hospital for treatment. On the first occasion.
Holt’s operation was performed, and gave relief. On the second occasion,
gradual dilatation by bougies was resorted to, and the man again discharged
relieved. Neglecting, however, in spite of warnings, to keep the canal
pervious by the constant use of the catheter, he had to be admitted
for the third time, three weeks previous to his death. The stricture had
been allowed to contract, an abscess had formed in the perineum, fistuke
existed here, and most of the urine was discharged through them.
Perineal section was performed, and again complete relief afforded. The
wound had nearly healed when he was attacked with uraemic symptoms,
and died comatose. Acute suppurative disorganisation of both kidneys
was discovered post mortems. ( See further, “ Surgical Post-mortem
Records,” vol. I, 1876, pp. 291-92.)

35. The urethra and bladder of a native male (Hindu) patient

admitted into hospital with extravasation of urine, producing
sloughing of the prepuce, scrotum, &c. He died from
septicaemia. (1) The urinary bladder is strongly contracted, all
its coats — but particularly the muscular— much hypertrophied,
the latter being half an inch in thickness. The inner surface
is thrown into prominent rugae or folds. (2) There is a perfora-
tion in the floor of the urethra, about an inch from the meatus.
This leads into gangrenous tissue surrounding the body of the
penis, and was continued into the scrotum, perineum, and
abdominal wall. (3) The meatus itself is much contracted — so
small, in fact, that it scarcely admits a probe. (4) An inch and
a half behind this is a long irregular stricture (rather more
than an inch in length). The urethral canal is again free for
an inch, after which another stricture, occupying the bulbous
and membranous portions, is met with. It is very hard and
fibrous. ( See further, “ Surgical Post-mortem Records,”

vol. I, 1878, pp. 533-34.)

36. “ Bladder, pubis, penis, and scrotum, illustrating an old stricture

of the urethra situated about an inch and a half from the meatus
urinarius externus, and infiltration of the urine into the sub-
cutaneous areolar tissue of the scrotum, which took place
through the perforating ulcer seen immediately behind the
right side of the bulb, indicated by a red glass rod. The
parieties of the bladder are much hypertrophied.” (Ewart.)
Presented by Professor R. O’Shaughnessy.

37. Urinary bladder, prostate, and a portion of the urethra of “ a

European, J. Y — , age from 30 to 40,” who died in Howrah
Hospital on the 20th of May 1837. (Webb’s P athologia Indicct,
No. 222, p. 209.)

The specimen shows (1) a tight, organic stricture of the urethra
situated in the bulbous portion of the canal. (2) Great dilata-
tion of the urethra behind the stricture, so that it is hollowed
out to form a cavity the size of a walnut, and projects
backwards beneath the middle lobe of the prostate. (3) Hyper-
trophy of the bladder, with great thickening, especially of

SEEIES XII.]

STRICTURE OF THE URETHRA.

425

the muscular coat ; the mucous membrane, on the contrary, is
thinned, and at the fundus presents a cribriform appearance,
due to a “ kind of hernial protrusion of the thinned mucous
lining between the disparted fasciculi of the muscular coat.”

38. The genito-urinary organs of a native male, aged 45, admitted

into hospital in a moribund condition with retention of urine.
He was relieved by eatheterism, and lived for three days in a
very weak and prostrated condition. The preparation exhibits
(1) a narrow organic stricture at the junction of the membranous
and bulbous portions of the urethra, with false passages
on either side, which run onwards into each lateral lobe of the
prostate. (2) The prostate itself, soft, swollen, and pus-
infiltrated. The prostatic urethra dilated. (3) Thinning and
atrophy of the coats of the bladder, with a highly vascular and
injected condition of the lining (mucous) membrane — in the fresh
state ; which also shows a reticulated and cribriform appearance
at the fundus. (4) Both kidneys are enlarged, highly vascular,
and juicy. Their surfaces and entire parenchyma thickly infil-
trated with small circumscribed abscesses, varying in size from
a millet-seed to a pea— (acute suppurative nephritis or “surgical
kidneys ”).

39. The urinary bladder, urethra, and scrotum from a fatal case of

extravasation of urine, — a native male, aged 32, who died within
an hour of admission into hospital. Perineal section was per-
formed. The patient had suffered from stricture (following
gonorrhoea) for two years. He had not passed water for 48 hours.
Catheterism was tried by native practitioners before admission
into hospital, but unsucessfully. When admitted, the perineum,
scrotum, penis, and lower part of the abdomen were swollen,
oedematous, and infiltrated with urine, evidently from laceration
of the urethra.

In the preparation, the bladder is seen to be small and closely con-
tracted. The muscular coat is enormously hypertrophied —
measures fully half an inch. The prostatic and membranous
portions of the urethra are dilated, and exhibit numerous false
passages on either side of the veru montanum, one of which leads
directly into the sinus poccularis, and extends backwards into the
middle lobe of the prostate. Another small round perforation
of the floor of the urethra passes outwards into the right lateral
lobe. The whole of the prostate gland was found dark and
sloughy, infiltrated with foetid purulent fluid. At the junction
of the membranous and bulbous portions, the urethral canal is
much narrowed, and the mucous lining thick and opaque. It is
at this spot that a tear in the floor of the urethra is seen, an
inch in length, running a little to the right of the median line,
and opening into the perineum by an orifice capable of admitting
a crow-quill. This appears to have been the result of forcible
catheterisation, and readily accounts for the extensive extravasa-
tion of urine. (The larger incision on the left side, communi-
cating with the perineum, is that made by operation after the
patient was received into hospital). There were multiple small

42 G

- . .%

STRICTURE OF THE URETHRA. [series xii.

abscesses and points of suppuration in both kidneys (“ sui’gical
kidneys”). ( See further, “Surgical Post-mortem Records,”
vol. I, 1S75, pp. 151-152.) ,

40. The urinary bladder and urethra of a native male, aged 50, who
died in hospital from exhaustion and septiemmia following
extravasation of urine into the perineum, scrotum, &c. The
mucous and muscular coats of the bladder are hypertrophied, —
the former much plicated and softened. As regards the urethra,
the first two inches are healthy, beyond which the canal becomes
exceedingly narrowed, owing to the presence of a long-standing
organic stricture, which extends from this point backwards to
(and including) the membranous portion. The new-formed
tissue external to the mucous membrane is firmest and thickest
at the bulbous portion of the urethra, cutting here almost like
cartilage. Just in front of the bulb, the lining membrane of
the canal exhibits two longitudinal lacerations, evidently produced
by forcible catheterisation. The whole of the bulbous portion
is sloughy and shreddy, riddled with false passages, and on
the right side has given way, causing extravasation of urine
into the perineum and scrotum, from the effects of which the
man died. The lateral lobes of the prostate are swollen and
soft. (“ Surgical Post-mortem Records,” vol. I, 1878, pp.
461-62.)

41. Bladder and urethra of a native male patient (Hindu), aged

about 85, showing (1) a stricture situated about two inches
anterior to the bulb of the urethra. (2) Several false passages
in the membrano-prostatic portion of this canal, which is dilated
so as to form a pouch capable of containing half a walnut. This
portion of the urethra has doubtless been the seat of organic
stricture, but is now so lacerated that it is impossible to dis-
tinguish its exact site and character. Of the false passages, one
leads downwards and to the right into the perineum, another
backwards and to the right into the corresponding lateral lobe
of the prostate ; a third enters the left lateral lobe of this gland ;
and a fourth, perforating the mucous membrane of the canal,
just above the veru montanum, passes onwards for about an inch,
undermining the mucous membrane of the neck of the bladder,
and perforates the same to enter the cavity of this viscus. All the
above are evidently due to improper and forcible catheterisation,
the patient having been treated by several native practitioners
(quacks) prior to admission into hospital. (3) The urinary
bladder was highly congested and ecchymosed ; the muscular and
other tissues are greatly thickened and hypertrophied. (4) There
is also much inflammatory thickening of the loose cellular tissue
around the neck of the bladder ; and (5) an extension of the same
to the recto- vesical pouch or fold of peritoneum, which was
coated by a thick layer of recent puriform lymph. There was,
moreover, general acute peritonitis. The patient was admitted
in a very low and prostrated condition. No difficulty Avas
experienced in passing a full-sized catheter into the bladder,
lie died from peritonitis.

XII.] STRICTURE OF THE URETHRA.

427

The urinary bladder and urethra of an East Indian patient,
aged 40, who had long suffered from organic stricture, and died
iu hospital of acute dysentery. The bladder is contracted and
its walls much thickened. At the neck and base the mucous
membrane is seen to be perforated in four or five situations,—
the openings leading into narrow sinuses, which burrow in the
submucous tissue, and communicate with the prostatic portion
of the urethra. These are obviously due to catheterism. The
floor of the prostatic portion of the urethra is considerably torn
by false passages. At the junction of the membranous and
bulbous portions is a dense cartilaginous stricture. The rest of
the urethra is healthy. (See further, “ Medical Post-mortem
Records,” vol. Ill, 1879, pp. 253-54.)

“Bladder and urethra of a European patient, the subject of urethral
stricture for five years. He was admitted on the 1st August 1864 ;
No. 3 catheter was passed with difficulty on the 2nd August, and
No. 9 on the 11th. Rigors followed the passing of the latter,
and the patient died with symptoms of pyaemia on the 13th.
(Colies.)

The stricture is situated in the membranous portion of the
urethra, and there are two or three superficial lacerations of the
mucous membrane of the neck of the bladder.

The urethra and bladder of a European patient, J. W — , aged 40,
who was operated upon twice for impermeable stricture. Rerincal
section was performed on both occasions, at an interval of eight
years. The patient died in hospital three months after the last
operation. The preparation shows (a) the cicatrix in the
perineum left by the operations ; ( b ) a hard, dense, bridled
stricture in the membranous portion of the urethra ; and (c)
a highly contracted small bladder, with excessive hypertrophy of
the muscular coat. Presented by Professor J. Fayrer.

The bladder and urethra of a European patient, aged 39, showing
a dense, bridled stricture at the membranous portion of the
urethra, with laceration of the canal anterior to it, the result
of catheterisation. The stricture is so narrow that a probe
is passed with difficulty through . it. Behind the stricture the
prostatic portion of the urethra is dilated, and scored by false
passages, especially towards the left side. The lateral lobes
of the prostate are enlarged. The urinary bladder exhibits great
hypertrophy of all its coats. ( See further, “ Surgical Post-
mortem Records,” vol. 1, 1876, pp. 257-58.)

Preparation showing a tear in the floor of the urethra, about three
inches from the meatus, leading into two or three false passages
on the right side of the membranous portion, which was found
highly congested and vascular, but with no evidence of
organic stricture. — From a native male, aged 20, who died
from intestinal obstruction. During life there was inability to
pass urine, perhaps owing to the congested condition of the
urethra and spasmodic contraction. The false passages are the
results of catheterisation.

428 HYPERTROPHY OF THE PROSTATE, [seeies xii.

47. The urinary bladder, scrotum, and urethra from a fatal case of

extravasation of urine, due to forcible catheterisation, and conse-
quent laceration of the urethral canal.

The patient, a native male, aged about 40, had bad gonorrhoea ten years ago,
which was followed by permanent but slight stricture. For the last ten
days (prior to admission) was suffering from fever, and yesterday, not
being able to pass water, a “ native doctor ” was summoned, who attempted to
pass a catheter into the bladder. No relief was obtained, and extravasation
of urine took place into the cellular tissue of the scrotum, perineum, &c.
In this state the man was brought into hospital. Although free incisions
were made into the infiltrated tissues, and a catheter passed into and
retained in the bladder, the patient gradually became low, and died from
acute diffuse cellulitis and septicaemia.

In the preparation, the bladder is seen strongly contracted, and its
coats much thickened. There are numerous false passages in
the mcmbrano-prostatic portion of the urethra, while the whole of
the bulbous portion, and up to within 2^ inches of the meatus,
this canal is extensively lacerated.

In the fresh state, presented a highly putrid, gangrenous, and softened
condition. The lacerations extend, on either side of the injured
portion of the urethra, into the perineal and scrotal tissues,
thus accounting for the rapid, intense, and fatal urinary extrav-
asation. ( See further, “ Surgical Post-mortem Records,” vol. I,
1875, pp. 217-18.)

48. “ Bladder and urethra. The former is greatly hypertrophied.

An almond-shaped calculus is seen occupying the site of the
prostate gland. One extremity points into the bladder at
the meatus urinarius internus, the other impinges upon the
membranous portion of the urethra. Anterior to this, and in
the membranous portion, there is a sacculated dilatation, which
contained a calculus, fragments of which are seen lying at the
bottom of the bottle.” (Ewart.) Presented by Dr. W. A. Green.

49. A preparation illustrating enlargement of the prostate gland,
especially of its third or middle lobe,— so commonly met with
in advanced life. — From a native male, aged 65.

50* Senile hypertrophy of the prostate gland. The lateral lobes are
especially enlarged, and, on section, firm and fibrous-looking.
The urinary bladder is contracted, and its walls thickened. In
the recent state, the mucous membrane was highly vascular
and ecchymosed. During life there was much cystitis, the
direct result of this hypertrophied condition of the prostate, and
a consequent inability to empty the bladder completely. No
stricture. — From a native male, aged 45. (“ Surgical Post-

mortem Records,” vol. I, 1876, pp. 251-52.)

51. Chronic hypertrophy of the prostate gland (lateral lobes). The
structure, on section, is firm and fibrous-looking ; it is infiltrated
with small calcareous concretions and corpora amylacea.
The urinary bladder is contracted, and its walls thickened.
The mucous membrane was very vascular and injected, with
a ring of small superficial ulcers at the neck. — From a native
male patient, aged about 40.

series xii.] HYPERTROPHY OF THE PROSTATE.

429

52. The genitourinary organs of a native patient, aged 55, who died
in hospital.

He was admitted with retention of urine and bleeding from the urethra, the result
of catheterism attempted by the “ native doctor ” of his village, the
day previous. It was said that Nos. 1 and 2 silver catheters were used.
A prostatic catheter was passed on admission, and about four pints of
bloody urine drawn off. The distended bladder had reached the umbilicus.
The prostate was found much enlarged. The bladder was relieved regularly
by catheterism in hospital, but the patient became very low and gradually
comatose. He died on the fourth day after admission.

On incising the urethra ( post mortem) a very distinct, hard, and
firm constriction is met with about two inches from the meatus ;
and, when the canal is laid open, an artificially torn stricture
is found here, the rent in the mucous membrane being quite
three-quarters of an inch in length. The submucous tissues are
thickened. The canal beyond is, as far as the bulb, fairly healthy,
but the whole of the membranous and prostatic portions of the
urethra are scored with false passages, which freely enter
the lateral lobes of the prostate. All three lobes of the prostate
are greatly enlarged, the lateral lobes being each about the size
of a duck’s egg, the middle a little smaller. The gland-tissue
is found abnormally developed and succulent, but not pus-
infiltrated; and, on section, broad fibrous bands are seen
intersecting each other throughout the lateral lobes. The middle
lobe seems to have undergone similar changes, and its upper
and anterior surfaces are deeply grooved. These grooves or
furrows have torn and ecchymosed margins, the results,
evidently, of forcible catheterisation. The upper surface has
been perforated in the same way, and shows no less than
six ragged openings leading into the bladder. This lobe
fills up and obstructs the neck of the bladder. The
latter was found occupied by broken down, soft, dark, blood-
coagulum mixed with urine (about half a pint). The mucous
membrane intensely vascular and ecchymosed ; the submucous —
especially the muscular — tissues greatly hypertrophied. The
ureters are ddated, particularly their pelvic expansions in the
kidneys ; their lining membrane very vascular and infiamed-
looking. The secreting structure of both kidneys is atrophied ;
the renal parenchyma generally abnormally vascular and juicy ;
the surfaces slightly rough, granular, mottled, and exhibiting
a few small simple cysts. No suppuration.

. Examined microscopically, sections from the prostate gland show great hypertrophy
of the proper structure, especially of the fibro-muscular tissue separating
and supporting the gland follicles. The smooth muscular tissue is much
thickened, and its nuclei abnormally numerous. The gland spaces, lined
by columnar epithelium, are in parts dilated; in others, apparently,
compressed and contracted. Blood vessels arc numerous and large,
particularly in the hypertrophied middle lobe, the structure of which is
almost uniformly stained of a dark red colour from blood extravasation.
There is no new or morbid cell growth. (See further, “ Surgical Post-
mortem Records,” vol. I, 1877, pp. 391-92.)

430

ABSCESS OF THE PROSTATE.

[SEEIES XII.

53. The bladder and urethra of a native (Hindu) male, aged 42, who

died of acute dysentery on the twelfth day after the operation
of lithotomy. The incision in the perineum is indicated by a
glass rod. Its margins were found superficially sloughy. It
communicates with the membranous portion of the urethra,
*V\ which is much lacerated, as also the left side of the prostatic
portion. The prostate is enlarged, particularly its middle lobe,
-*! which may be seen projecting into the neck of the bladder, and
■*/ forming here a fungus-like excrescence, nearly as large as a
walnut. In the removal of the stone this middle lobe seems
to have been almost completely divided. ( See further, “ Surgical
Post-mortem Records,” vol. I, 1SS0, pp. 669-70.)

54. “ Abscess of the prostate, which had led to extensive disorgani-

sation of the gland. The parieties bulge greatly towards the
right side. The left ureter is much dilated, owing to obstruc-
tion at its termination in the bladder, where a fungous growth*
is seen projecting into its cavity. That of the opposite side,
though slightly enlarged, is quite pervious. There seems to be
an ulcerated opening into the right vesicula seminalis. The
bladder exhibits thickening of its mucous and muscular tissues,
by which its natural capacity has been very considerably dimin-
ished.” (Allan Webb’s Patliologia Indica, No. 218, p. 211.)

55. Urinary “ bladder of a native woman, which came away en masse

as a slough. The patient was admitted with typhoid symptoms.
The neck of the bladder is much thickened and partly ulcerated.
The viscus has been opened from behind. Above and anteriorly
it retains what seems to be a part of its peritoneal coat.”
(Colies.) Presented by Professor D. B. Smith.

56. A specimen showing laceration of the urinary bladder during the

operation of ovariotomy. A rent, through which three fingers
may be passed, exists on the posterior surface. This was only
discovered post mortem. The patient, a native female, aged 26,
survived the operation for about 36 hours. Death took place
from extravasation of urine into the peritoneal cavity, and conse-
quent acute and general peritonitis. ( See further, prep. No. 94,
Series XIV, and “Obstetric Post-mortem Records,” vol. I, 1880,
pp. 735-36.)

• Fungus-like excrescence of the thickened mucous membrane.— J. F. P. McC.

SERIES XIII.] INDEX.

Series XIII.

INJURIES AND DISEASES OF THE MALE
ORGANS OF GENERATION.

INDEX TO THE SERIES.

A.— THE PENIS—

1. — Wound, 1.

2. — IlYPEP-TEOpnY OF THE PREPUCE (“ ELEPHANTOID "), 2, 3, 4,20,

28, 29, 30, 31.

3. — Ulceration of the prepuce, 5, 6, 7, 8.

4. — Hard chancre, 9, 10, 11.

5. — Soft chancre, 12, 13.

6. — Warty growth, 14.

7. — Epithelioma :*

(a) Of the prepuce, 15, 16, 17, 18, 21.

(b) Of the glans penis, 16, 17, 19, 20, 21, 22.

8. — Malformation of penis, 23.

B.— TIIE SCROTUM—

1. — Elephantiasis :

(a) Simple, 24, 25, 26, 27, 28, 29, 30, 31.

(b) Noevoul, 32, 33, 34.

2. — Results of operations for elephantiasis scroti, 35, 36, 37,

38, 39.

3. — Papilloma (warts), 40, 41.

.C.-THE TESTICLE—

1. — Atrophy, 42, 43, 44, 45, 46, 47, 49.

2. — Chronic orchitis, 48.

3. — Hydrocele, 49, 50, t 51, f 52, 53, 64, f 55, 56, 57, 58, 59, f 60. J

4. — Results of operations for radical cure of hydrocele, 61, 62.

5. — IIjematocele, 63, 64, 65, 66.

* Sec also Series XVII.
t Those marked thus urc double,
t “ Congenital.”

432

ELEPHANTIASIS PREPUTII.

[SERIES XIII.

6. — Spermatocele, 45 (?), 47.

7. — Suppuration op tunica vaginalis, G7, 68.

8. — Calcareous infiltration of tunica vaginalis, G9, 70, 71, 72, 73

74, 75.

9. — Morbid growths :

(а) Tubercle (scrofulous orcliitis), 76.

(б) Fibroma, 77.

( d ) Carcinoma, 80, 81.

(e) Sarcoma, 82.

1. “ An incised wound extending the whole way round the prepuce.

On the upper surface it is superficial, but it is deep on the under
aspect, dipping down into the corpus spongiosum, not, however,
penetrating the urethra. The boy is supposed to have died
from the haemorrhage which followed an unsuccessful attempt at
circumcision.” (Ewart.) Presented by Dr. Herbert Baillie.

2. “A good specimen of elephantiasis preputii, involving the scrotum

subsequently. The tuberculated condition of the skin so
characteristic of these growths when they arise from the prepuce
is well seen.” (Colles.) Presented by Professor J. Fayrer.

3. “ Elephantiasis scroti et penis. The skin is greatly thickened

and fissured, giving to it the appearance of a badly executed
pavement. The epithelial lamina is the one-twelfth of an inch,
while the cutis vera and subjacent cellular tissue measure fully
three-quarters of an inch in thickness. The hair has generally
become atrophied, and fallen off.” (Ewart.)

4. “ Penis of a lad of 14 removed on 31st December 18G5, near the

pubis, for elephantiasis preputii of three years’ duration. It
has been split open from below, and the course of the urethra
is marked by a black glass rod. The penis and glans are
healthy ; the disease, as usual, only affecting the prepuce.
The mass, when removed, weighed 7^ ounces, and measured seven
inches round its thickest part.” (Colics.) The preparation
illustrates the formidable operation considered necessary, in
former times, for the removal of a simple growth of this nature.
Presented by Assistant Surgeon 13. W. Switzer, f.r.c.s.i.,
Civil Surgeon, Kohat.

5. A preparation consisting of about two inches of the anterior

portion of the penis, including the prepuce and glans, amputated
for supposed malignant disease. From a native male patient,
aged GO. There was a history of syphilis. The preputial
orifice is much contracted, and the foreskin almost entirely
adherent to the glans and corona glandis. A quantity of
purulent and sebaceous, highly putrid secretion occupied the
slight interspace between these parts. The surface of the glans
and its orifice are ulcerated, and a series of small, shallow,
unhealthy ulcers extends along the urethral canal.

SEMES XIII.]

PHAGEDENIC ULCERATION.

433

There is no evidence, from microscopic examination, of any epitlic

(cancerous) proliferation from the surface or in the su >s1 .nice
of the glans penis, prepuce, or corpus eavernosum. The ulceia et
condition of the parts described, appears to be the resu t o
prolonged irritation and inflammation from the retention
much sebaceous secretion beneath a partially adherent and vei)
tight prepuce.

The patient made a good recovery.

(3. Plvagedienic ulceration of the penis, — probably syphilitic. About
an inch of the anterior portion of the organ has been removed,
under the impression that the disease was epitheliomatous.
There is, however, no evidence of cancerous structure in the
ulceration. Two large ulcers are seen, — one, situated on the
sulcus of the glans, just below the frenum, which has destroyed a
considerable portion of the glans substance, and laid open the
urethra. It presents an eroded and irregular margin, and, at one
part, supports a wart-like growth, the size of a small hazel-nut.
The other ulcer is separated by a narrow strip of unaffected
skin from that just described. It also has an eroded and slightly
fungoid appearance. The orifice or meatus of the penis is much
contracted. There is no prepuce.

Microscopically examined, the epidermis at the margins and surfaces of the ulcers
shows exuberant growth, and contributes principally to the fungoid appear-
ance of the larger ulcer. There is, however, no deep infiltration of
epithelium. The subpapillary layer of the skin is found densely infiltrated
with a small-celled or nuclear growth, — apparently especially aggregated
in large amount around the capillary vessels of the part, which arc
enlarged and numerous. The appearance is very like that observed in
connection with the development of hard chancre upon the propuce or
glans.

7. “ A calculus as largo as a small hazel-nut, impacted just behind

the prepuce. It is in situ, and the prepuce is seen much tume-
fied. The stone has escaped from the urethra, and now appears
underneath the integument.” (Ewart.)

The concretion referred to does not appear, on examination, to be a
urethral (or vesical) calculus. It is very improbable that a
“ stone ” of this size could escape per urethram, and, moreover,
its structure is found to consist principally of soft sebaceous
material with an infiltration of fine calcareous particles. It
seems, therefore, to have resulted from the accumulation of
sebaceum beneath a phymotic prepuce (with a very contracted
orifice), which substance has slowly formed a concretion, into
which calcareous deposit has taken place.

8. Phagedoenic, syphilitic ulceration of the prepuce. The latter has

partially sloughed, exposing the glans penis, and then cicatrised
around it. The meatus is very small and contracted, — scarcely
admits the end of a probe.

The patient, a native male, aged 30, died in hospital from pneumonia.

9. Specimens of hard chancre affecting the prepuce, which, in each

case, has been removed entirely. From two native out-patients.

Examined microscopically, the cutis to a slight extent, and the subcutaneous tissues
more especially, are found infiltrated with a small-celled or nuclear growth

431 SYPHILITIC ULCERATION (CHANCRES). [series xiii.

The proliferation is most abundant in the deeper layers, — below the ulcer-
ated surface, (where both cuticle and cutis vera have perished, and are
replaced by pus-corpuscles). The blood vessels are large, and the nucleated
growth seems to be particularly abundant in connection with them. The
“ nuclei” are about the size of leucocytes, and stain readily with carmine.
Presented, by Dr. E. Lawrie.

10. An indurated Hunterian chancre of the prepuce removed, with

a portion of the latter, from a native male (out-patient), aged
about 30.

11. A specimen of a hard or Hunterian chancre of the prepuce,

removed, with the whole of the latter, by circumcision. — From
an adult native.

12. Circumcised phymotic prepuce covered with soft sores (chancres).

— From a native out-patient, aged 25.

13. Four specimens of circumcised prepuces infected with soft chancres

in various stages of ulceration. Obtained from native out-
patients attending the surgical dispensary of the hospital.

Presented by Dr. E. Lawrie.

14. A warty growth or papilloma of the prepuce. — From a native

male (a carpenter), aged 30. It first made its appearance as a

small pimple near the frenum preputii. There was no history
of syphilis.

The growth is about the size of a goose-egg. Its external surface is
rough, nodulated, and warty. Shows no ulceration. Feels hard,
firm, and horny. On section, the colour is pinkish-white ; the
warty character is continued into the tumour-substance deeply, —
the upper two-thirds being composed of a papillary structure,
the interstices of which are filled with a soft, white, waxy
material — altered epithelium and fatty matter ; the lower third is
smooth and fibrous-looking, and exhibits the sections of several
loops of blood vessels.

These appearances are confirmed on microscopic examination The epidermal layer
of the skin is chiefly affected. The epithelial proliferation is very abundant,
and numerous “ nests ” or “ globes ” are scattered throughout the same.
The papillae are well defined, but do not seem to extend deeply into the sub-
jacent cellular tissue. The bloodvessels are large; and both the fibrous and
elastic tissue elements are strongly developed. The firmness of the growth,
and the limitation of the epithelial proliferation to its legitimate (epidermal)
matrix, indicate a warty, not cancerous, structure.

15. Epithelioma of the prepuce. A flattened fungous growth, with

very exuberant, cauliflower-like protuberances, separated by deep
and narrow fissures. Consistency soft — readily crumbling under
pressure of the fingers.

All the characters of true epithelioma are well seen in microscopic
sections. There are numerous “ nests,” and deep epithelial pro-
longations.

A small portion of the glans penis is also involved. No history.
Presented by Professor J. Fayrer.

16. Epithelial carcinoma of the prepuce and glans penis. The growth

is large, profusely luxuriant, and consists of huge papillated
excrescences with deep fissures between them, forming a kind of

SERIES XIII.]

EPITHELIOMA OF PENIS.

435

thick fringe or rampart around the glans penis. The latter is
firmer in consistency, but its surface is also warty or granulated.
The urethral orifice is indicated by a glass rod. The penis has
been amputated one inch behind the corona glandis.

Under the microscope, sections taken from both glans and prepuce exhibit luxuri-
antly proliferating epithelial cylinders, with numerous nests (some visible to
the naked eye), and all the other characters of epithelioma. In the deeper
portions of the growth an abundant nuclear infiltration is observed, and also,
very large and thin-walled capillary blood vessels.

17. “ Epithelioma of the penis, removed from a European.” The growth

involves the whole of the prepuce, forming a fungous, highly
papillated ring or corona round the glans. The latter is also
involved, and on its inferior aspect deeply ulcerated. The struc-
ture is quite characteristic. Presented by Professor J. Fayrer.

18. A very typical specimen of epithelioma of the penis, involving

both prepuce and glans, and forming an irregularly rounded
fungating mass, the size of a small orange. No history.

19. Epithelioma of the penis, from a Hindu, aged 40. “ The disease is

said to have been of 18 months’ duration. No history of
syphilis.”

This is a mass, about the size of one’s fist, having an irregularly conical
outline, and greatly tuberculated, and (in parts) ulcerated surface,
the latter, in particular, at the situation of the meatus. The
whole of the glans penis is involved. On longitudinal section,
the cauliflower-like structure of the growth, with its very
greatly hypertrophied papillae, is well seen. The urethral
canal is almost obliterated, and the disease has extended
backwards into the corpora cavernosa, — but anterior to the
part where amputation has been performed.

On microscopical examination, all the characters of a true, luxuriantly proliferating
epithelioma are found. The papillary hypertrophy and deepening are most
marked. Epithelial “nests” abundant, and a free nuclear proliferation
in the sub -papillary strata of the cutis. Blood vessels large and numerous.
In parts, the epithelial cells are noticed to have very finely but distinctly
serrated margins, and to be closely interlocked. These serrated cells seem
to be the older ones, for their nuclei are indistinct or absent, and their
protoplasm highly granular from fatty metamorphosis.

Presented by Professor Gayer.

20. Epithelioma of the penis, — a five months’ growth. — From an
Fast Indian, aged 62. Amputated by the galvanic ecraseur.

The growth affects the whole of the glans, which is enlarged, distorted,
and tuberous, forming a mass the size of a duck’s egg, or a
little larger. The consistency is soft. The urethral canal is
much contracted owing to the concentric pressure of the tumour.
Examination, under the microscope, reveals all the characters
of quickly -growing, true epithelioma. The cell-proliferation
is abundant, and reaches deeply into the subcutaneous struc-
tures. There are numerous “globes,” small and large, and
considerable development of the dermal blood vessels.

21. Epithelioma of the penis. The prepuce is phymotic, and much

contracted at the orifice. On one side, two large fungating

436

ELEPHANTIASIS SCROTI.

[semes XIII.

growths aro seen, originating in the glans penis (concealed),
and projecting through the prepuce, which is ulcerated, and
secondarily involved.

The structure, microscopically, is typically cancerous (epithelial). No
history.

22. Epithelioma of the penis — “ from a native male patient.” The-

disease affects the glans and corona glandis, and extends for a
short distance into the body of the organ beyond. The
structure is quite typical on microscopic examination, and the
growth forms a rounded, slightly lobulated, creamy-white
excrescence, which is very soft in consistency, and crumbles
readily on pressure and section. There is no prepuce — probably
owing to circumcision.

23. “ Specimen illustrating double penis, removed from a child who

had also imperforate anus. The rectum terminated in the fundus
of the bladder. There is a globular mass underneath the
scrotum, which may possibly have been a superfluous scrotal
bag.” (Ewart.) Presented by Dr. Cheek.

24. “ Elephantiasis scroti. The growth is large, and shows well the

immense hypertrophy which the integument has undergone.
The epithelial layer is granulated and fissured, mostly coloured
with the dark pigment of the native skin ; but in some places
completely white and destitute of pigmentary deposit.* *******
The hair follicles are much increased in size, but the scattered hairs
are short and stunted. Beneath the integument, the outgrowth
consists of an immense accumulation of fibrous tissue, the bands
of which can be distinctly seen.” (Ewart.) Presented by Pro-
fessor J. Fayrer.

25. “ Elephantiasis scroti. On the front aspect the epithelial layer of

the integument is seen enlarged into large lobules, varying from
the size of a pea to that of a walnut. These lobulated masses are
conical, having their narrow ends attached to the cutis vera, and
their basial ends free. Viewed on the surface, they are square,
oblong, or polyhedral, from pressure ; and they are more or less
devoid of pigmentary deposit.

On the other aspect, the surface of the skin is covered with smaller
granulated eminences, also, to a great degree, devoid of pigment.
The interior consists of hypertrophied dartos, fibro-cellular tissue,
and unstriped muscular fibre.” (Ewart.) Presented by Baboo
Kasi Nath Datta.

26. “ Elephantiasis preputii ct scroti. The lobulated, and albinoid,

or semi-piebald character, the outgrowth often assumes in the
native, is well demonstrated.” (Ewart.)

27. A portion of an clephantoid scrotum,— probably from a European.

No history.

28. “ Elephantiasis of the scrotum and penis. The skin and subcutane-

ous structures are hypertrophied. The prepuce is studded
over with condylomatous excrescences.” (Ewart.)

29. A good example of a small elephantoid growth of the scrotum

and prepuce. The preparation is interesting as being one of the
earliest specimens removed by the modern method ol operation,

SERIES XIII.]

ELEPHANTIASIS SCROTI.

437

i.e., by excision of the morbid integumental structures only,
the testicles being preserved. Presented by Professor J . Fayrer.

30. Elephantiasis of the scrotum and prepuce, weighing 19 ounces,
and said to be of ten years’ growth. — From an East Indian,
H. K., aged 52. Preserved as a typical specimen of the disease
occurring in an East Indian.

31. Elephantiasis of the scrotum and prepuce, weighing 25 ounces.

Removed by operation from an Irishman, M. O’B., aged 40.

History.— The patient, born in Ireland, and of pure European parentage,
'came out to India as a child (at the age of eight years). Has
had elephantiasis of the right leg for about the last 20 years.

This still persists, and appears to be extending upwards to the thigh.
The scrotal hypertrophy commenced about five years ago. Has
enjoyed fair health, with the exception of occasional attacks of
“ fever and ague,”— more frequent during the last five years.
Has noticed the scrotum and leg to “ swell ” more after each
such attack. Is ruddy-looking, and otherwise apparently quite
healthy. Has always lived in Calcutta.

• Examined microscopically, the structure of the growth is found identical with that
of the non-ncevoid variety, so common in the natives of Bengal. The
hypertrophy of the smooth muscular tissue (dartos) is exceptionally well
marked. The cellular infiltration is not as abundant or so uniformly
distributed as in most typical specimens. The cutis proper exhibits great
thickening. a

32. “ Elephantiasis scroti. The surface is much nodulated, and

some of the nodules bled considerably before the tumour was
removed.” (Ewart.) This is a good specimen of the noevoid,
as distinguished from the simple variety of elepliantoid
growths of the scrotum. The surface is more softly and
minutely lobulated, and the excrescences, in numerous situ-
ations, are vesicular or bullar rather than solid in character.
From these there was doubtless the escape of sanguineous
serum or lymph during life, referred to as “bleeding” in
the description above given. The whole tumour has a reddish-
brown colour, and may be said to resemble, somewhat, a
gigantic raspberry. Presented by Professor S. B. Partridge

33. A portion of an elephantoid growth of the scrotum, of noevoid

variety. The external surface is in parts ulceratad, in others
raised into characteristic fungoid and softly tuberculated
excrescences. Miscroscopic examination confirms the nature of
the growth. The testicle — much atrophied and its structure
greatly disorganised — is seen towards the lower part of the section
of the tumour. Presented by Professor It. O’Shaughnessy

34. A specimen of lymph-scrotum, — the so-called noevoid elephan-

tiasis, removed by the usual operation from an East Indian
aged 31. The skin of the scrotum is raised into larger and smaller5
smooth, soft, rounded excrescences, many of which contain a
clear or milky fluid. This escaped during life on puncture or

(Tiimour d&tailed MC0Unt 01 the minutc structurc of elephantoid growths, see Scries XVII

438

ELEPHANTIASIS SCROTI.

[semes XIII.

accidental abrasion, was found to be highly albuminous, and
to contain numerous lymphoid corpuscles, leucocytes, a few red
blood-cells, and filariae (P. sanguinis hominis of Lewis'). After
removal, the whole of the scrotum and prepuce were carefully
dissected and examined for a mature nematoid, but unsuccess-
fully. The structure, otherwise, is strictly characteristic.

35. A preparation showing the result of a successful operation for

the removal of elephantiasis of the scrotum. The penis and
testicles are seen re-covered by integument, which, although
lacking in pigment in parts, and more rigid and cicatricial in
character than normal, is nevertheless healthy. Presented by
Professor J. Fayrer.

36. A similar specimen.

37. A preparation illustrating the appearances presented by the

penis and testicles after a successful operation for elephantiasis
scroti, — by the usual method. In this case the tumour was a
large one, — weighing, just after removal, 29 pounds. The
patient, a native, aged 18, made a good recovery, but, while
still in hospital, was attacked with pneumonia, from which he
died.

38. A similar specimen, from a native male, aged 23, who also

recovered completely from the operation, but died subsequently
of pneumonia.

39. Perfectly cicatrised condition of the wound after the removal of

an elephantoid tumour of the penis and scrotum. The subject
was a native adult, aged 35, who succumbed to a sudden attack
of pneumonia, quite unconnected with the operation, and on the
53rd day after the latter, when he was, apparently, quite
convalescent.

40. “ Epithelial, cauliflower-looking excrescences removed from the
scrotum of a native, supervening, from protracted irritation,
upon elephantiasis scroti, believed to be innocent.” (Ewart.)

This is purely a warty growth, superadded to an already elephantoid scrotum.

Examined microscopically, the papillomatous structure of the large, super-
ficial, fungoid-looking mass is well defined. There are no “nests;” no
epithelial proliferation beyond or deeper than the epidermal layer.
Beneath this, the connective tissue and smooth muscular tissue of the
dartos are found hypertrophied, the former also infiltrated with leucocytes
and lymph-corpuscles; the lymph-channels dilated; the blood vessels larce
and numerous, — all these well-known characters of elephantoid structure
are readily recognisable. — J. F. P. McC.

41. Scrotum of a native, showing a series of rounded warty growths,

which on section, although exhibiting a characteristic papillary
structure, are peculiar from having undergone considerable
calcitication.

42. “ Extreme atrophy of the testes in a Hindu boy sixteen years of age.

They seem to be mere flattened expansions of the cords, being
about three-quarters of an inch long and a quarter of an inch
thick.” (Ewart.) No history. Presented by Professor Allan
Webb.

SERIES XIII.]

ATROPHY OF THE TESTICLE.

439

43. Atrophy of the testis duo to the pressure exercised upon the

organ, and interference with its nutritive supply, by the over-
growth of the scrotal tissues in elephantiasis, — a very common
consequence or result of this disease. The atrophied testicle is
not much larger than an almond, and may he seen dissected out
of the surrounding parts, and supported by two glass rods.

44. Atrophy, with calcareous infiltration of the right testicle and
spermatic vessels. From an aged native (jet. 60), operated
upon for elephantiasis scroti. The testis is greatly atrophied.
Its proper structure can only be distinguished at the upper
part of the longitudinal section which has been made through
it. At the lower part, the testicular structure has been
replaced by a soft sebaceous mass, consisting principally of
fat and cholesterine crystals. The tunica albuginea is greatly
hypertrophied, and partially calcareous ; and the spermatic
vessels, having undergone similar transformation, can be seen as
convoluted, varicose-looking, rigid tubes spread over the posterior
aspect of the preparation.

45. Atrophy of the left testicle from a case of elephantiasis

scroti. It was surrounded by a large hydrocele, and was so
much disorganised as to necessitate removal. The spermatic
tubules are much atrophied and infiltrated with fat. A cyst,
the size of a sparrow’s egg, is seen at the situation of the
globus major of the epididymis, — probably a spermatocele.
A portion of the greatly thickened tunica vaginalis is left
in situ. The elephantoid scrotum was of thirteen years’
growth, and weighed, on removal, 13 pounds. Presented by
Professor Gayer.

46. Atrophy of the testicles, and great thickening of the tunic;e

vaginales, from a case of scrotal tumour (elephantiasis) ; — a
native aged 30. The testes and coverings being diseased were
removed at the time of the operation (excision of the growth).

Both the tunica vaginalis and tunica albuginea are greatly hyper-
trophied and partially calcified. Both testes are reduced in
size, and microscopic examination of their structure shows
considerable atrophy of the tubuli semeniferi, with fatty degen-
eration of their epithelial contents.

There was a small, and evidently old, hydrocele on each side.

The atrophic and degenerative conditions of the testicles are
attributable to the compression exercised by the greatly
thickened tunics upon the nutrient blood vessels of these organs,
and the consequent interference with their proper vascular
supply.

47. Atrophied testicles from a Malay, aged 25, who died of epilepsy,

from which disease he has suffered for about four years. He had
an almost incontrollable tendency to masturbation. Each testis ■
has a well-formed and healthy-looking tunica vaginalis ; the
tunica albuginea is thickened, and sends broad dissepiments
into the secreting structure. Between these tunics, springing
from the globus major of the epididymis, there are two small
cysts in the left testicle, and one in the right. They contain

440

HYDROCELE.

[series XIII.

a milky opalescent fluid of mawkish odour, exhibiting, under
the microscope, a large amount of fatty granules and mole-
cules, degenerated and withered epithelial cells, and a few
filamentous parti cles,--— probably disintegrating spermatozoa.

The testis-structure is well formed, but in parts the semeniferous tubules appear
to be compressed, and to have lost their epithelial lining, from the abnormal
growth of the connective tissue originating and extending from the
fibrous septa of the tunica albuginea. This tissue is abundantly nucleated,
and here and there irregularly pigmented. The tubular epithelium is also
abnormally fatty.

48. Chronic orchitis (? syphilitic). No history. The testicle is enlarged
and very firm. On section for the most part smooth, but here
and there exhibiting small circumscribed granules of soft,
yellowish, cheesy matter.

On microscopical examination, the chief change consists of an
abnormal hypertrophy of the intertubular connective tissue, which
is associated, in parts, with a scanty nuclear growth. The
tubules are either compressed or but little altered, and their
contents, similarly, are either healthy or undergoing cheesy
transformation. The small, disseminated, opaque granules above
described appear to consist of such transformed tubular contents.

49. Old hydrocele of the tunica vaginalis testis, with much thickening

of the sac, and recent inflammatory deposit upon its inner
surface. The tunica albuginea is also hypertrophied ; the testicle
compressed and atrophied.

50. “ Double hydrocele. The penis is in situ, but the skin and dartos
have been removed, and on the right side the tunica vaginalis
propria is exposed. The pyramidal shape of the hydrocele on
the left side is well shown.” (Ewart.)

51. Double hydrocele. The tunicae vaginales are much thickened and

hardened, and the internal surfaces of each are rendered opaque
and irregular from long-standing chronic inflammation.
(Ewart.) Presented by Mr. Yanderstratten.

52. The sac of an enormous hydrocele, from which “ 182 ounces of

fluid were removed.” The tunica vaginalis is greatly thickened,
and its lining membrane rough, with adhering shreds of lymph.
The patient, an old man, died from diarrhoea contracted in
hospital.” Presented by Professor S. 13. Partridge.

53. “ Tunica vaginalis of a hydrocele laid open. It is much thickened

and hypertrophied, and its internal surface much roughened
and irregular from lymph deposit. A strong band is seen
stretching across from the tunica vaginalis propria to the tunica
vaginalis reflexa. The testis occupies the upper and back part
of the hydrocele.” (Ewart.)

54. Hydroceles of the tunicse vaginales. The left is larger, and

somewhat hour-glass shaped ; it contained about half a pint
of serous fluid. The right, smaller, is characteristically pear-
shaped, and contained about three ounces of similar fluid. (Both
are now stuffed with cotton-wool to natural size.) — From a native
male, aged 20, who died in hospital of chronic dysentery.

SERIES XIII.]

HYDROCELE.

4-1 L

55. An old hydrocele, removed ])ost mortem, from a native male,

aged 50. * The tunica vaginalis is greatly thickened— in parts
measuring a third of an inch, and also partially calcified. It
contained about a pint and a half of turbid serum. The
testicle, very much compressed and atrophied, may be observed
at one side of the sac.

56. Hydrocele of the right tunica vaginalis, obtained on post mortem

examination of a native male, aged 32, who died of pneumonia.
It is about the size of the foetal head, is typically pyriform in
shape, and filled with clear, amber-coloured, serous fluid.

57. A hydrocele of the right tunica vaginalis, of characteristic shape,

and of the size of one’s fist.— From a native, aged 45, who died
of cholera.

58. A similar but larger specimen of hydrocele of the left tunica

vaginalis. — From a native, aged 50, who died of acute dysentery.

59. Two hydroceles (right and left), obtained post mortem, from

a native male, aged 45, who died of apoplexy. The left is
the larger, and weighs 34f ounces ; it is preserved entire.
The right is smaller, and has been stuffed with tow.

60. An interesting variety of congenital hydrocele, consisting of
a sac, which extended probably from the abdomen (peritoneum)
along the cord to the testicle. It measures fully eight inches in
length, and is constricted just above the testicle, so as to present
a somewhat hour-glass shape. The abdominal or upper end is
now closed, but below, it is continuous with, in fact forms the
tunica vaginalis testis. This lower portion of the sac is a good
deal thickened. The testicle is healthy ; its proper structure may
be viewed from the section made on the posterior aspect of
the preparation.

61. A preparation showing the result of operation, by tapping and

injection, upon a hydrocele of the right tunica vaginalis, after
an interval of about six weeks. The parietal and visceral
layers of the serous membrane are united or glued together by
a considerable quantity of soft, gelatinous-looking, finely-
fibrillated material — evidently organising inflammatory exudation
or lymph. The testicle is healthy. From a European, aged 40,
who died in hospital of apoplexy.

62. Radical care of hydrocele. The right testicle and coverings of a

Mahomedan, aged 35, illustrating the mode of obliteration of
the sac of the tunica vaginalis after operation for a small
hydrocele. A large quantity of yellowish organising lymph fills
the interspace between the parietal and visceral layers of the
membrane, and is undergoing consolidation and fibrillation.
The testicle is a little compressed and atrophied.

63. “ H .Hematocele of the right tunica vaginalis, with great thicken-

ing of the sac, which was filled with coagulated blood. The sac
is now turned inside out, and is seen covered with a finely
granular lamina of coagulable lymph.” (Ewart.) Presented
by Professor Bedford.

64. “ Great enlargement, thickening, and induration of the left
tunica vaginalis, which is seen filled with a coagulum of blood.

142 CALCIFICATION OF TUNICA VAGINALIS, [series xiii.

The right tunica vaginalis is also much thickened and fdled with
a blood coagulum. Both sacs on being opened contained also a
small quantity of sanguineous fluid. Both testes are partially
disorganized.” (Ewart.) No history.

65. “ Haematocele. The tunica vaginalis was found distended with

coagulated blood. The sac is thickened, and much roughened
on its internal surface by fibrinous deposition. A section of the
testicle shows that the tunica albuginea is thickened, but that
the parenchyma of the organ is healthy.” (Ewart.) Presented
by Dr. Esdaile.

66. A hsematocele of the left tunica vaginalis. The latter is much

thickened, and contains a blood-coagulum the size of an orange.
At the lower part of the preparation the testicle is seen com-
pressed, and invested by a greatly indurated tunica albuginea.
From an Abyssinian, aged 35.

67. “ Suppuration of the tunica vaginalis, the whole of which (here

preserved) came away through a wound formed by sloughing of
the scrotum.” (Colles.)

Portions examined microscopically show that, on the inner surface of the membrane,
the epithelium is in a state of rapid proliferation, and covered with exuda-
tion material, i.e., small, round, granular cells, with minute blood vessels,
and amorphous matter, Presented by Professor J. Payrer.

68. A portion of an “ elephantoid ” scrotum exhibiting acute

suppuration of the right tunica vaginalis. At the operation
nearly a pint of pus with several large blood clots were
evacuated from the sac, the inner surface of which presents a
highly thickened and inflamed condition, and is covered by
soft, vascular, shreddy material — lymph.

69. Calcification of the tunica vaginalis, which forms a rigid-walled {

cyst, the size of a walnut. The testicle appears to be healthy.

70. “ An enormously thickened tunica vaginalis, containing a

deposit of calcareous material, and having its interior lined by
ragged coagulable lymph.” (Ewart.)

71. “ The large sac of a hydrocele, having white chalky deposits in

its walls. It contained a dark red material, furnishing innu-
merable plates of cholesterine, small fat globules, yellow
granular matter (haematosine), and a small number of granular
cells of different sizes.” (Ewart.) Presented by Babu Nil

Madub Mookerjee.

72. “ Extensive calcareous degeneration of the tunica vaginalis from

a case of elephantiasis scroti. The mineral material exists in
plates, which are so numerous as to give the sac the appearance
of a shell slightly intermixed with organic or fibrous texture.”
(Ewart.)

73. “ Calcareous degeneration of the tunica vaginalis. . The inside of

the sacs is roughened and rendered more or less villous from the
deposition of lymph.” (Ewart.)

74. A portion of the left tunica vaginalis of a native patient, aged

GO, who was operated upon for a large scrotal tumour (ele-

phantiasis scroti).

8EBIES XXII.]

SCROFULOUS ORCHITIS.

443

Flattened calcareous plates and irregular-shaped concretions are exten-
sively distributed in the very greatly thickened and fibroid
tissue of this membrane. The testicle was much atrophied.
( See prep. No. 44.)

75. The testicle and its coverings from a case of scrotal elephantiasis,

— removed by operation. The tunica vaginalis is enormously
thickened, in parts fully a quarter of an inch in diameter. It is
studded, here and there, irregularly, with large calcareous plates.
The tunica albuginea also shows much fibroid thickening. The
testicle is compressed and atrophied. Presented by Professor
S. B. Partridge.

76. Left testicle of a native patient, a Mahomedan, aged 35. The

man was admitted with an inflamed scrotum, the skin over the
left testicle being especially tense, shiny, dusky-red, and painful.
An incision was made into this part, and a small slough of the
cellular tissue evacuated thereby. Two days after, the testicle
was found protruding through the wound, as a large fungating
mass. The glands in the left groin were slightly enlarged.
The testicular tumour was not at all painful, but the patient
looked very cachectic, and it was thought advisable to remove
the organ entirely. The other (right) testicle was also a good
deal enlarged, and felt indurated. There was no history of
syphilis.

The testicle preserved is rather larger than a duck’s egg. Its surface
is slightly lobulated. On section smooth, but showing, amidst a
pinkish basis-substance, a very large number of minute, round,
opaque dots or granules, — the obstructed and dilated cross-
sections of the semeniferous tubules.

These are seen still more distinctly in fine sections prepared for the microscope.
Great proliferation of the intratubular epithelium is found, with marked
obstruction and irregular dilatation of the seminal tubules. The shred
epithelium is highly granular and fatty, and, in parts, has quite broken
down into an amorphous debris, The general parenchyma of the testis
(the intertubular tissue) is the seat ot an extensive nuclear and small-
celled growth. The cells are lymphoid-looking,— with single or double
nuclei, slightly granular, and round. Blood vessels are somewhat deficient,
and small in calibre.

The consistency of the testis is throughout very soft. It is somewhat
dumb-bell shaped, the growth appearing to affect the upper
end (epididymis) and lower portion, both of which form globu-
lar expansions, while the intermediate segment is less involved.
The structure of the new growth and the morbid changes in
the testicle are at once characteristic of scrofulous orchitis.
Presented by Professor Gayer.

77. A fibroid tumour of the left testis. Removed from a native

aged 45. The growth was of seven years’ duration. The
glands in the groin were enlarged. No history of syphilis.

This is a tumour about the size of two fists, covered by greatly
thickened “ elephantoid ” skin and dartos. It is of oval shape,
and slightly lobulated. The central portion of the growth is
hollowed out into a deep crater-like cavity, with irregular and

<144 SYPHILITIC ORCHITIS. [series xiii.

ragged, suppurating walls. Large portions of the tumour-tissue
were discharged from this part during life. The cut surface of
the growth has a dull, opaque-white colour, and fibrous appear-
ance. Portions of the proper testis-structure can still be seen,
but compressed and surrounded by broad white bands of fibrous
tissue, and therefore more or less atrophied or broken down
into small pseudo- cysts. The consistency and structure

generally are very firm and dense.

On microscopical examination, the true testis-structure is found much atro-
phied ; the tubuli semeniferi compressed and obliterated, and the surround-
ing or supporting connective tissue densely crowded with small round
cells, with a scanty fibrillating intercellular substance. In parts more
removed from the testis, and forming the greater bulk of the tumour, the
structure is more truly fibroid, consisting of dense broad bands of white
fibrous tissue interlacing closely with each other, or forming slit-like
parallel meshes, which are occupied by lymphoid corpuscles (mono-nucle-
ated, slightly granular cells). The sections of a good many small arteries
come into view. The growth is essentially fibro-cellular ; shows in the main
no tendency to the formation of cheesy nodules or softenings, and involves
the testicular structure only partially. The greater bulk seems to be a
development from the tunica albuginea and other non-glandular portions
of the testis. It appears, therefore, to be a fibroma, which has probably
accidentally inflamed, and in part has thus softened, suppurated, and
been discharged.

Presented by Professor Gayer.

78. A. fungus-testis ” (right). Removed from an East Indian r

aged 31. “ It is said to have originated from a blow on the
testicle received seven months ago, followed by enlargement,
inllammation, and ulceration. There is no history of syphilis
or gonorrhoea.”

The skin over the testicle is seen to have ulcerated, and, through the
opening thus formed — (rather larger than a rupee) — about one-
fourth of the organ protrudes. On section, the whole testicle
is firm, thickened, fibrous in appearance, and of a yellowish-
white colour.

Sections examined microscopically, reveal a very abundant small-celled or
nuclear infiltration of the intertubular tissue. The cells are round or
oval, and in parts, are observed developing into a spindle-celled fibrillated
tissue. The semeniferous tubules are widely separated, and, at the same
time, compressed by this new growth, but their lining epithelium is not
shred, — only granular-looking and atrophic. No empty tubules. No
caseous or lymphoid deposits.

The morbid appearances most closely resemble the results of syphilitic
infection, i.e ., gummatous growth or syphilitic orchitis.
Presented by Dr. E. Lawrie.

79. Right testicle of a European, John A — , aged 26, removed on

suspicion of being a malignant tumour. It is said to have been
of four months’ duration.

The whole testicle is enlarged, so as to form a pyriform tumour, the
size of one’s fist. On incision, in the fresh state, the cut
surface presented a somewhat glistening, pale-bluish colour,
with here and there patches more opaque and whitish in appear-

445

SEBIES

XIII.]

CARCINOMA OF THE TESTICLE.

ance. The testis-structure has undergone complete transforma-
tion. It is firm but elastic, and somewhat juicy.

On microscopic examination, the seminal tubules are found distended, dilated, and
ruptured; the secreting cells (epithelium) in a state of rapid proliferation.
The intertubular connective tissue is hyperplastic,— crowded with nuclei
and small round cells. These conditions are maintained pretty uniformly,
with also, some fatty and molecular disintegration of the cell-elements,
both tubular and intertubular.

The appearances closely resemble the structure of a rapidly developing
gummatous growth, not tending to form circumscribed nodules,
but occurring more as an infiltration, and probably, therefore,
the morbid changes are to be referred to syphilitic infection. _

80. Carcinoma testis. The whole of the testicle and the tunica
albuginea are involved, and small secondary nodules are also
seen developing in the course of the spermatic cord. Ihe
growth in the testicle is nodulated, and forms an irregularly
pyriform mass, the size of a small orange.

On microscopical examination, there is found marked thickening of the intertubulai
connective tissue, which is also split up into narrow slits or interspaces,
filled with round nucleated cells, rather larger than leucocytes. They
exhibit but slight heteromorphism. This is the structure also of the
smaller nodules in the substance of the cord. Ihe semeniferous tubules
are either dilated and ruptured, or have entirely disappeared. The
intratubular contents are highly granular and fatty.

81. Enkephaloid carcinoma of the testicle. The preparation exhibits

the right testis, presenting an enlarged, swollen, and softened
condition, and which protruded in fungating form through an
ulcerated opening in the scrotum. The superficial portion of
the organ is greatly disorganised, partially sloughy, and pus-
infiltrated ; the deeper portions show the following changes on
microscopical examination.

Proper (secreting) structure extensively destroyed. The tubules that exist are
compressed, have lost their epithelial lining, and many are quite closed.
The connective tissue around them is in a most actively proliferating
condition, and presents, in parts, an epithelial transformation of the
newly-formed cells. Such cells are large, round or oval, nucleated, highly
fatty, and heteromorphic.

The left testicle was healthy. The lumbar glands, the lungs, and liver,
were secondarily infected, i.e., infiltrated with small nodules of
soft cancer. The subject was a European, aged 43. He referred
the disease to injury, — a contusion of the testicle in a railway
collision, 18 months prior to his admission into this hospital.
(See further, “ Surgical Post-mortem Records,” vol. I, 1875,
pp. 237-38.)

82. Roth testicles of a native aged 45, removed on account of malig-

nant disease. The right testicle is much enlarged, has a pyriform
shape, and is about the size of two fists. The left is smaller.
Roth are diseased. The consistency (especially of the right) is
very soft and succulent, and both organs are highly vascular.

SAECQMA OF THE TESTICLE. [series xm.

The bulk of the morbid growth and enlargement affects, in each
testis, chiefly the epididymis.

Examined microscopically, sections show an atrophic condition of the semeniferous
tubules, their lining epithelium has almost completely disappeared, and their
channels are occupied by granular, amorphous, fatty material. Around the
tubules, and composing the bulk of the enveloping new growth, is a densely
cellular structure,— the cells about three times the size of blood-corpuscles
nucleated, and of a very regular, rounded or oval shape. No diversity in
size or shape of these elements can be distinguished, and there are only ‘here
and there traces of an intercellular fibrous or fibrillated tissue. The latter
exhibits no disposition into a true stroma. Blood vessels are very numerous
and large, especially in the right testis, the sections from which, moreover,
show extensive, dark, granular pigmentation. The inguinal glands on the
left, and the lumbar and inguinal glands on the right side, were similarly
infiltrated;— all enlarged, swollen, very soft and pulpy.

I' pon the whole, therefore, the morbid growth more closely resembles sarcomatous
uhan cancerous structure, and may be regarded as a small round-celled
sarcoma of both testicles. (“ Surgical Post-mortem Records,” vol. I, 1877
pp 393-94.) Presented by Professor Gayer.

)

SEMES XIV.]

INDEX.

447

Series XIV.

INJURIES AND DISEASES OF THE FEMALE
ORGANS OF GENERATION.

INDEX TO THE SERIES.

A.— THE UTERUS.

I.— MALFORMATIONS —

1. — Bicornuate uterus, 1.

2. — Double uterus, 2.

II— DISPLACEMENTS—

1. — Ante-flexion, 3, 51.

2. — Inversion, 4.

III.— INJURIES—

1. — Punctured wound, 5, 6.

2. — Laceration or rupture during delivery, 7, 8, 9.

3. — Hysterotomy, 10, 11.

4. — CiESAREAN SECTION, 12.

IV.— DISEASES —

1. — Hypertrophy—

(a) Of the cervix and os uteri, 13, 14.

(b) Of the whole organ, 15, 16, 17, 18.

2. — Atrophy, 77.

3. — Metritis and endometritis, 15, 16, 17, 18, 19, 20, 21.

4. — Laceration and sloughing after parturition, 20, 22, 23.

5. — Results of abortion (criminal or otherwise^, 6, 19, 24, 25,

26, 27, 28, 29, 30, 31, 32.

6. — CoAGULA EXPELLED FROM THE UTERUS, 33, 34.

7. — Tumours and morbid growths*:—

a b a a

(a) Myoma and myo-fibroma, 35, 36, 37, 38, 39, 40, 41,

b b a c d a (l e b

42, 43, 44, 45, 46, 47, 48, 49, 50, 51.

* See also Series XVII, (Tumours, &c.).

a. Polypoid; 6. Interstitial or iutramural ; e. Spontaneously expelled; d Cvstic-
e. Calcified. ' '

448

INDEX.

[series XIV.

(i) Carcinoma, —

i. Scirrhus, 52.

ii. Enkephaloid, 53, 54, 55, 56.

iii. Epithelioma, 57, 58, 59, 60.

8. — Gravid uteri, 63, 64, 65, 66.

B.— THE OVARY.

I.-MALFO RMATION —

1.— Congenital absence of one ovary, 67.

II.— DISEASES—

1. — Atrophy, 68.

2. — Abscess, 69, 70, 71, 72, 73.

3. — Tumours and morbid growths* —

(a) Fibroma, 74.

(b) Carcinoma. 53, 55, 75.

(d) Cysts —

i. Simple, 3, 35, 77, 78, 79, 80.

ii. Multilocular, 81, 82, 83, 84, 85, 86.

iii. Proliferous, 87, 88, 89-

iv. Dentigerous (sebaceous, pilous, &c.), 90, 91.

4. — Cysts removed by ovariotomy, 92, 93, 94.

5. — Preparations showing corpora lutea (of pregnancy), 25, 29, 66,

95, 96, 97.

C.-THE FALLOPIAN TUBE.

I. -DISEASES—

1. — Dilatation, 70, 76, 98, 99, 100.

2. — Occlusion, 100.

3. — Inflammation and suppuration, 70, 101.

4. — Tubercle, 76, 100 (?).

D,— THE BROAD LIGAMENT.

1. — Cysts, 37, 102.

2. — Fibroma, 103.

E.-THE VAGINA.

1. — Laceration, 104, 105, 106.

2. — Fistula, 107.

3. —Prolapsus, 108.

* See also Series XVII, (Tumours, &c.).

SERIES XIV.]

DOUBLE UTERUS.

449

4. — Ulceration, 109.

5. — Sloughing, 20.

6. — Polypoid growth (fibroma), 110.

F.— THE VULVA.

1. — Malformation, 111.

2. — Sloughing, 112.

3. — Elephantiasis (myxo-fibroma), 113, 114, 115, 116, 117, 118, 119,

120.

4. — Condyloma, 121, 122, 123, 124, 125, 126.

1. A bicovnuate uterus. It consists of a vertical portion, an inch

in length, formed chiefly by the cervix. From this, passing
obliquely upwards and outwards, on either side, is a kind of
double uterine body — pyriform cornua. These are rounded and
expanded at their distal extremities, narrow where they join
the common cervical canal. Each is a little over an inch in
length. The ovaries are small ; on section pale and anmmic,
but dotted with a few dark pigmentary deposits.— From a
native girl, aged 14, who died in hospital of gastro-enteritis, &c.
(“ Medical Post-mortem Records,” vol. Ill, 1S79, pp. 7-8.)

2. Double uterus and vagina. — From a native female, aged 18, who

committed suicide by hanging The vagina) are distinct and
separate. The left is a little larger than the right ; — the latter
has been somewhat torn on removal post mortem. There is a
' thick fibrous septum between these canals, continued upwards
also between the cervical portions of the twin uteri, but, at
about the point where each cervix terminates in the body of the
corresponding uterus, the separation between these organs
becomes more complete, so that the rounded fundus of each
uterus is quite free. The left is a little the larger organ.
There are two ovaries with corresponding Fallopian tubes and
round ligaments ; these structures being connected with Uie
outer border of the right and left uterus. On incising the
ovaries, several well-formed Graafian vesicles are found ; two or
three contained small dark blood coagula. “ Judging from the
skin of the abdomen and breasts, tbe woman had never had a
child,” but had probably menstruated regularly.

Presented by Dr. Gordon Price, Civil Surgeon, Jessore.

3. A preparation illustrating marked anteflexion of the uterus, the

body of which is enlarged. The ovaries exhibit simple cystic
degeneration. No history. Presented by Mr. Cullen.

4. Chronic and persistent inversion of the uterus, “ constituting a

tumour almost as large as the fmtal head, which is lying external

to the labia majora. The investing membrane of the tumour

the lining membrane of the uterus— is dense, opaque, and
unyielding.” (Ewart.) Presented by Babu Dwarkanath Bose.

5. Uterus showing at its fundus a punctured wound, an inch in

length, evidently produced by some sharp-pointed instrument.

450

RUPTURE OF THE UTERUS.

[series XIV.

“ Half the body of a foetus of about the third month is exhibited,
protruding from the womb into the abdominal cavity.” The
uterine tumour is about the size of one’s fist. No history.

6. A specimen showing perforation of the fundus of the uterus by

a piece of vegetable substance— a rootlet, said to be that of the
“ seth kuroopee ” (Nerium odor uni) , introduced for the purpose
of producing abortion. The rootlet is about as thick as a
knitting-needle ; has been passed though the os uteri up to the
fundus, and has pierced the latter about a third of an inch on the
inner side of the right Fallopian tube, — nearer the anterior than
the posterior surface of the uterus.

“ Pelvic cellulitis and circumscribed peritonitis, with matting of several
coils of the small intestine and of the sigmoid flexure, and
suppuration within the pelvis was the result. Death resulted—
judging from post mortem signs — in about seven days.”
Presented by Dr. J. O’Brien, Civil Surgeon, Burdwan.

7. “ Uterus and contents at the full term of gestation. The head

is seen to have been passing the os when the spontaneous rup-
ture of the womb anteriorly, and at the junction of the cervix
with the body of the organ, took place ; the rent is sufficiently
large to admit the fist, and has given exit to the left arm of the
foetus and a portion of the umbilical cord.” (Ewart.)

Presented by Dr. Palmer.

8. Spontaneous rupture of the uterus during labour. The prep-

aration shows a large transverse rent in the anterior wall of the
uterus, about an inch above the os. Through this a mature
foetus was completely expelled into the abdominal cavity. The
placenta was also detached, and found just within the edges
of the rent, gently grasped by the same. A large amount of
blood (over 30 ounces), partly fluid, partly coagulated, was
found in the peritoneal cavity. The foetal head was directed
downwards, and occupied the whole of the left lumbar and
hypochondriac regions, — the colon, and coils of the small intestine
being pushed to the right. The circumference of the contracted
uterus, — at the level of the attachment of the ovaries, — measures
12 inches. The circumference of the foetal head was 13| inches.

The subject was a native female, aged 25, brought to the hospital
moribund, and who died within ten minutes of admission.

9. A dry preparation of the pelvis in the above case. The bones are

slender and ill-developed. The promontory of the sacrum
projects forwards unusually, and narrows the inlet considerably,
while the outlet is similarly constricted by an abnormal approx-
imation of the spines of the ischia and point of the coccyx.
The following measurements were recorded on removal of the
soft parts : —

Inlet of pelvis, (a) conjugate or antero-posterior diameter — 3 inches;
(b) transverse diameter— 4 inches ; ( c ) oblique diameter— 4

inches.

Outlet of pelvis, («) conjugate diameter — 2^ inches; ( b ) transverse
diameter — 3i inches. (A portion of the coccyx has unfortunately
been lost.)

SEMES XIV.]

CiESAREAN SECTION.

451

10. Uterus of a native female, showing the results of internal or

vaginal hysterotomy performed during labour. “ The patient had
been in labor for 36 hours. The head presented, and was well
down, but the os uteri was obliterated, and showed no signs of
being opened up. The operation was performed at 1-30 p.M.
(21st March 1865). Death took place at 11 p.m. the same day.
The interior of the cervix is seen to be continuous with that of
the uterus, and to present the same shaggy aspect. The
incisions made into it do not extend to the peritoneum at any
part.” (Colies.) Presented by Professor T. E. Charles.

11. The greater portion of a conical cervix uteri removed by ampu-

tation. The operation was rendered necessary on account of the
“ exceedingly irritable and hyperaesthesic condition of this pro-
lapsed portion of the organ. The results were highly satisfac-
tory.” Presented by Dr. J. Ewart.

12. Uterus illustrating the section made in the Caesarean operation per-

formed by Dr. Webb in order to save the life of a child after the
death of the mother from fracture of the base of the skull, with
laceration of (and extravasation of blood into) the brain. “ Some
said the patient had been dead half an hour, others an hour,
others an hour and a half.” Dr. Webb’s account of the operation
and its results is as follows : —

“ A longitudinal incision through the integuments of the abdomen in the course of
the linea alba exposed the womb, which was apparently warmer than
natural. It was opened in the same manner at its upper anterior aspect,
where it had nothing intervening between it and the abdominal parieties ;
but the placenta was attached over the spot which had been cut open,
and it bled freely. By passing the hand quickly lower down between this
and the uterine walls, the membranes were distinguished ruptured, and
the child readily delivered. The infant was still quite warm, not quite
full grown, and of a good colour. Attempts were made to establish respi-
ration by inflating the lungs through a tube, but these were ineffectual.
The child became cold, more and more livid. I desisted, and returned to
lay it by the mother, when I was surprised to observe that the toomb, from
having filled all the abdomen, had so contracted as to have spontaneously
extruded part of the placenta

The contracted uterus, with the extruded placenta, and the incision made
by the operation, are all readily recognisable in the preparation.
(Webb’s Patlioloyia Indica, No. 835, p. 308.)

13. Hypertrophy with chronic induration and elongation of the

posterior lip of the os uteri, from which, during life, “ a polypus
had been removed.” The structure of the lip is very firm and
compact. The normal fibro-muscular tissue is found, under the
microscope, greatly increased, the mucous glands enlarged and
dilated, the blood vessels of abnormal size or calibre, and every-
where a free nuclear proliferation developing into connective
tissue.

14. Excessive hypertrophy of the anterior lip of the os uteri. (The

organ has been opened from behind.) It forms an outgrowth
the size of a duck’s egg, which completely filled the anterior
cul-de-sac of the vagina. The external surface is a little rough
and excoriated. In the recent state was highly vascular and 'of

452

ENDOMETRITIS.

[series XIV.

a purplish colour. The section made through it shows that its
structure is homologous, and directly continuous with that of the
cervix. The canal of the latter is dilated and elongated. The
uterus is small, its cavity empty ; the Avails are a good deal
thinned at the level of the ostium internum, — From a native
woman, aged about 40, who died in hospital of pneumonia. ( See
further, “ Medical Post-mortem Records,” vol. I, 1873, pp.
247-48.)

15. Endometritis after delivery. The uterus is enlarged to about

three times its normal size, and its walls proportionately
thickened. The lining membrane presents a shreddy and sloughy
appearance, and is much softened and swollen.

16. “ An inflamed uterus. The muscular substance is softened, and

the mucous membrane coated Avith a fine lamina of flocculent
lymph.” (EAA^art.) No history.

Presented by Babu Chunder Coomar Dey.

17. “ Uterus and appendages of a Hindoo primipara, who died about

the end of the first month of pregnancy. The walls of the
organ are slightly enlarged, and its internal surface is softened
and villous from inflammatory changes folloAving the expulsion
of the ovum.” (Ewart.)

18. Uterus showing chronic inflammatory thickening, roughening,

and villosity of the lining membrane, Avith some enlargement of
its cavity, and thickening of its walls, — the results of “ dysmen-
orrhceal inflammation” (chronic endometritis).

Presented by Professor Allan Webb.

19. “ Uterus and vagina, the internal surfaces of which are greatly

inflamed by the means employed to produce criminal abortion.”
(Ewart.) No history.

Presented by Babu Nil Madub Mookerjee.

20. “ Sloughing of the vagina and neck of the uterus, the body of
which is much softened, inflamed, presenting on its internal
surface a ragged and villous appearance.” (Allan Webb.)
This condition folloAAred instrumental delivery at the full term
of gestation. ( Patliologia Indica, No. 850, p. 288.)

21. The uterus and right ovary of a native female, aged 55, Avho died

from Morbus Brightii. The uterus is as large as one's fist. The
cervix is slightly elongated, and its canal obliterated from the os
externum to the os internum. A probe can be passed through
the former, but will not penetrate the latter. The uterine cavity
is seen to be filled by a soft, pulpy, grumous, pultaceous mass,
Avhich, under the microscope, consists of large granular cells,
altered blood-corpuscles, and much fat, — no muscular or fibrous
tissue. It is probably,, therefore, a large broken down or
. disintegrating blood-clot. The lining membrane of the uterus
is entire, and constitutes a cyst-like investment for this material.
The uterine walls are much thinned and atrophied.

The right ovary is the size of a pigeon’s egg, very hard, and firm ; on
section shows considerable fibroid thickening, with fatty and,
in parts, calcareous degeneration.

seuies xiv.] ILLUSTRATIONS OF ABORTION.

453

The changes in the uterus are probably the result of endometritis, i.e.,
obliteration of the cervical canal and extravasation of blood
into the uterine cavity, around which this organ has enlarged.
The condition is a rare one at such an advanced period of life.

22. Extensive laceration and sloughing of the upper part of the

vagina and cervix uteri, in a case of death after parturition. The
uterus is large, its walls are much thickened, and the whole
organ is imperfectly contracted. The lining memberane is soft,
swollen, and shreddy. No history.

23. “ Sloughing and sphacelus of a part of the body, and the cervix

uteri and upper part of the vagina, from a woman at the full
term of utero-gestation.” (Ewart.)

24. “ Uterus inflamed, and covered externally with layers of lymph.

The lal chittra stick now in the cavity of the organ had been
employed to produce criminal abortion. The consequent
inflammation of the substance of the uterus and of the peri-
toneum was the immediate cause of death.” (Ewart.)

Presented by Baboo Dwarka Nath Bliose.

25. Uterus and ovaries of a native woman who died in hospital of

tetanus, and who had probably aborted a short time previously.
The os uteri was found open ; the lips thickened, bulbous, and
highly vascular. The interior of the uterus presented a dark
purplish colour ; and, at the fundus, may be seen a small, raised,
sloughy patch, with considerable villous thickening of the mucous
membrane — probably the attachment of the foetal placenta.
The left ovary exhibits a very fine specimen of true corpus
luteum of about the third month.

Presented by Professor Chuckerbutty.

26. The uterus and ovaries of a native female, aged 24-, who died from

tetanus. The left ovary contains a true corpus luteum. The
uterus presents all the appearances of having been recently occu-
pied by an ovum. It is enlarged ; its walls are thick and soft ;
the lining membrane swollen and highly vascular,— towards the
fundus, shreddy-looking with portions of detached decidua. The
cause ol the tetanus was probably abortion, produced criminally
or otherwise.

27. The vagina, uterus, and ovaries, from a case of tetanus, following

apparently abortion, although no history of the same could be
obtained from the patient,— a native female, aged 36. The
vagina is wide ; it is superficially abraided in both culs-de-sac
around the os uteri. The latter readily admitted the finger, and
its margins are slightly fissured. The uterus is about the size of
a cricket-ball. Its walls are thickened and vascular. The
lining membrane soft, swollen, and highly injected;— at one
portion of the anterior wall of the fundus, over a limited space,
presents a raised, ragged, and villous appearance, as if indicating
the site of a small detached placenta. Both ovaries are swollen
and vascular ; the left contains a true corpus luteum.

(See further, “ Medical Post-mortem Records,” vol. I. 1875
727-28.) ’ ’ 11

454

CRIMINAL ABORTION.

[series XIV.

28. Uterus showing a large V-shaped laceration of its posterior wall,

with great vascularity, softening, and sloughing of the lining
membrane, and intense inflammatory disorganisation of the
uterine appendages. Obtained on post mortem examination of
the body of a native female, a widow, aged 35, who died an hour
after admission into the hospital. She is stated to have aborted
in the third month of pregnancy. The injury to the uterus
must have been produced mechanically, i.e., by means of some
sharp-pointed instrument. There was a large extravasation of
blood and serum (39 ounces) into the peritoneal cavity, and
general acute peritonitis. (“ Obstetric Records,” vol. I, 1875,
pp. 235-30.)

29. Uterus and ovaries, from a native female, aged 30, a prostitute,

who died from tetanus. The uterus shows evidence of recent
impregnation and abortion. Its walls are thick, soft, and
vascular ; the lining membrane the same, and, at the fundus
(posterior wall), over a space about the size of a rupee, there
is a prominent, villous-looking patch, indicating probably the
situation of the detached placenta. In the right ovary a
large true corpus luteurn may be observed, the size of an
unshelled almond, and with a well-defined, yellow, crenated
margin, quite three lines in/diameter. (See further, “ Medical
Post-mortem Records,” vol. I, 1876, pp. 987-88.)

30. The uterus and ovaries of a native female, aged 28, admitted

into hospital with symptoms of tetanus, and who died within
six hours.

The uterus is the size of a large orange ; its walls are thick and
highly vascular. The lining membrane is soft, dark-purplish
in colour (in the fresh state), and superficially sloughy
towards the fundus, where also, it is raised in a fungus-like
form over a limited space, rather larger than a rupee
(florin), — evidently marking the site of a small detached
placenta. In the right ovary there is a large, well-defined
corpus luteurn, with a deep orange-yellow coloured, crenated,
and pigmented margin.

These conditions render it impossible to doubt that abortion had
recently taken place, either naturally or induced by artificial
means, and that the tetanus was really traumatic.

Floating freely, but moored by a delicate thread of connective tissue to the
fimbriated extremity of the right Fallopian tube, is a simple serous cys'
about the size, shape, and colour of an ordinary white grape.

31. The uterus and ovaries of a Bengali female, aged 28, a maid-

servant, who died from tetanus, probably the result of abortion
criminally induced. The posterior lip of the os uteri is torn
and partially perforated, as if by some sharp instrument.
The uterus is enlarged; its lining membrane exceedingly
vascular, soft, and swollen. Near the fundus— posterior wall—
there is a ragged thickened patch, — the remains of a small
detached placenta. In the left ovary a corpus luteurn of
pregnancy is seen, oval in shape, about the size of a two-

UTERINE MYOMATA.

455

V '

SERIES XIV.]

anna (three-penny) piece, and with a crenated yellowish margin.
(“ Obstetric Post-mortem Records,” vol. I, 1879, pp. 601-602.)

32. Uterus from a case of tetanus following abortion, — a native

female, aged 30. There are several small lacerations in the
situation of the os internum, one of which, on the left side,
is very deep, and,, in fact, stops very little short of actual per-
foration. It looks as if produced by a sharp-pointed piece of the
lal chittra (. Plumbago rosea) , so commonly employed for this pur-
pose (abortion). The uterus is enlarged ; its walls thickened ; the
lining membrane soft, superficially sloughy, and, at the fundus,
exhibits a tufted appearance, — the site of the detached placenta.
Both ovaries are enlarged, and were found highly vascular ; in the
right is a true corpus luteum of pregnancy, the size of a two-
anna (three-penny) piece. (“ Medical Post-mortem Records,” vol.
Ill, 1879, pp. 339-40.)

33. A divided blood-clot, of pyriform shape, expelled spontaneously

from the cavity of the uterus,— (probably dysmenorrhceal). Its
inner surface is smooth, its external reticulated and velvety in
appearance. It seems to have formed a complete mould of the
interior of the uterus.

34. A firm coagulum taking the shape or mould of the cavity of the

uterus, and expelled, in the act of straining at stool, in case of
dvsmenorrhoea.

35. A fibrous tumour” (myoma) “ springing, by a broad base, from
the internal surface of the fundus uteri, and filling the enlarged
cavity of the organ to within the quarter of an inch from the os
internum. It is as large as a hen’s egg.” (Ewart.) There is a
simple, unilocular cyst of the left ovary, a little larger in size
than the uterine tumour. Presented by Dr. Herbert Baillie.

36- A huge myoma, completely filling the uterine cavity, and inti-
mately connected with the walls of the uterus, except just
above the situation of the ostium internum. It is oval in
shape, accurately moulded to the interior of the uterus, and
measures 7 inches in length, 4 inches in breadth (at the widest
part), and from 3 to 4 inches in thickness. The uterine parieties
at tho cervical canal, where still free, are seen to be a good deal
thinned ; the rest of the organ has expanded to a commensur-
ate degree with the growth of the tumour, and, together with the
latter, forms an ovoid mass as large as the adult head.

37. Preparation showing (1) a polypoid myoma filling the cavity of
an enlarged uterus. It is attached by a broad base or pedicle
to the posterior wall of the fundus, and receives an investment
from the lining membrane, which forms a distinct capsule to the
growth. The latter displays, on section, a concentrically
arranged, fibroid-looking structure. The walls of the uterus
are nearly half an inch in thickness. (2) On the right side,
— developing apparently between the layers of the broad ligament
— is a multilocular cyst, the size of a small orange. The right
ovary and Fallopian tube are inseparably connected to the upper
part of this cyst. The ovary appears to be atrophied.

Presented by Assistant Surgeon Tamccz Khan.

456 MYOMATA OF THE UTERUS. [series xiv.

38. An interstitial myoma, developing in, and occupying the whole

of the posterior wall of the uterus. It is the size of a large
orange, and forms an irregularly rounded projection at the
back of the uterus. The structure is very firm owing to
partial calcification. The uterus is small and flattened, appar-
ently from the pressure of the growth. A glass rod has been
passed into its cavity through the os.

Presented by Professor Mouat.

39. A fibroid tumour (myo-fibroma) of the uterus, as large as a

melon. The growth has developed from the whole of the
external surface of the body of the organ. The outline of the
latter, imbedded in the mass, and presenting a narrowed and
elongated character, with an anteflexed condition of the cervix,
is indicated by glass rods.

Presented by Baboo Nil Madub Mookerjee.

40. “ Uterus and appendages showing a polypus ” (myoma) “ of pyr-
amidal shape, hanging by a narrow pedicle from the mouth of
the womb into the vagina.” (Ewart.)

41. Preparation showing the uterus and vagina with a polypoid

myoma, the size of a small orange, projecting through the os,
and completely filling the vagina. (A portion of the anterior
wall of the latter has been removed in order to display the
growth more satisfactorily.) The pedicle of the tumour is
long and narrow, and attached to the posterior wall of the
fundus uteri. Presented by Baboo Dwarka Nath Bhose.

42. An intramural fibroid tumour (myoma) of the uterus, the size of

a cricket-ball, developing from the upper part of the fundus,
and producing much distortion of the organ in this situation.
The cavity of the uterus is enlarged, and its walls below the
growth are abnormally thickened and rigid. — From a native
female, aged 55.

43. Two small fibroid tumours of the uterus; one, an interstitial

development in the anterior wall of the organ, just beyond the
ostium internum, the other springing from the superficial aspect
of the right wall of the cervix. Both growths have distinct
capsules, and each is composed of dense, concentrically arranged,
white fibrous tissue, with a very small amount of smooth
muscular fibre. — From a native female, aged 35.

44. A myoma, the size of a nutmeg, growing from the external or
free surface of the fundus uteri. It is firm, has a short thick
pedicle, and is encapsuled by peritoneum continuous with that
investing the body of the uterus. The fibro-muscular structure
has a somewhat concentric arrangement, as seen on section of the
little tumour. — Taken from a native woman who committed
suicide by hanging.

Presented by Assistant Surgeon Gopal Chunder Roy, Howrah.

45. A similar specimen. The uterus and ovaries of a native woman,

aged 35, who died from dysentery. There is a myoma, the size
of a nutmeg, and with a short thick pedicle, growing from the
fundus into the peritoneal cavity. It receives a capsular invest-
ment from the serous membrane, continuous with that covering

SERIES XIV.]

POLYPOID FIBRO-MYOMATA.

457

the rest of the organ. The right ovary is in a state of cystic
degeneration.

46. A large uterine polypus, which was spontaneously separated and

expelled. It was found occupying the outlet ot the vagina, and
readily removed. Apparently the pedicle had divided by
sloughing. From a native female, aged 40. The growth was
probably of about two years’ duration, during which period the
patient had suffered from repeated attacks ol uteiine
haemorrhage.

The polypus is about the size of the foetal head ; ovoid in shape. At
the narrow end the ragged and sloughy remains of the pedicle
may be seen. The tumour is firm but elastic in consistency ;
has a well-defined, fibrous capsulp ; a pale pinkish-white colour,
and fibroid appearance on section. Examined microscopically,
presents all the characters of a true myoma.

Presented by Baboo Ivlietur Nath Mittra, l.m.s.

47. A tumour, the size of a walnut, and having a perfectly smooth

surface, removed by the ecraseur Irom the uterus ol a native
woman, aged 52, who had been suffering for six months from
recurrent metrorrhagia.

The little growth is firm and fibrous-looking on section, but displays
several circumscribed softenings and small sanguineous cysts ;
the former consisting of creamy, broken-down tumour tissue,
the latter of softly coagulated blood.

On microscopical examination, the structure is found to be fibro-cellular,
— the cell elements predominating ; with also, a scanty develop-
ment of smooth muscular tissue. The blood vessels are large and
numerous, their walls very thin and delicate. The tumour is,
therefore, an actively growing fibroma (of the cellular type), but
including in its structure a certain amount of smooth muscular
tissue, i.e., a fibro-myoma.

Presented by Professor T. E. Charles.

48. A large fibroid tumour filling the uterus, and removed by the
ecraseur. From a married East Indian female, aged about
25. No exact information could be obtained as to the duration
or period of growth of the tumour. It is a flattened, broad-
based growth, the pedicular attachment of which is indicated
by an oval excavation on one side, three inches in length and
two in breadth. The surface is moderately lobulated. On
section it is very firm and dense, fibrous-looking, and laminated —
a series of fibroid nodules closely united together, the fasciculi
of each having a pretty regularly concentric arrangement. The
sections of numerous large blood vessels are also brought into
view on incising the tumour, showing its abundant vascularity.
In size it is rather larger than the foetal head.

Examined microscopically, thin sections exhibit a fibro-myomatous structure. The
(smooth) muscular development is considerable ; the nuclei large, and many
of them infiltrated with fat granules and globules. The muscular fasciculi
are bound together — in concentrically arranged bundles — by firm wcll-
formed connective tissue, having also numerous nuclei. The tumour is
therefore a true fibro myoma. Presented by Professor T. E. Charles.

458

CARCINOMA OF THE UTERUS.

[SEBIES XIV.

49. The uterus of an aged East Indian female (ait. 80), who
died from chronic diarrhoea, &c*, showing a polypoid growth
attached to the anterior wall of the fundus. It is about the
size of a betel-nut, myomatous in structure, and throughout
thickly infiltrated with small serous cysts, many of which are
also found in the surrounding portion of the uterine wall.

50- “ Large fibroid tumour of the uterus, which has undergone cre-

taceous degeneration. One ovary contains a fibrous tumour,
the other has not been removed.” (Colles.)

The tumour is roughly ovoid in shape, — the size of a turkey’s egg. It
involves chiefly the posterior and left lateral walls of the uterus,
and is very dense and firm in consistency. An almost complete
shell of calcareous matter forms a kind of capsule to the growth,
and calcareous particles are also freely distributed throughout
its substance. The uterus is greatly atrophied, and has been
so much compressed by the tumour that its cavity is almost
obliterated. Presented by Baboo Juggabandhu Bose.

51. Myoma of the uterus, the size of a nutmeg, developing inter-
stitially in the anterior wall of the fundus. There is an
indistinct line of a demarcation — no distinct capsule — separating
it from the surrounding uterine tissue proper. It is seen to
have produced marked ante-flexion of the organ.

On microscopical examination, the nucleated fibro-muscular tissue is
very abuudant, and forms more or less concentrically arranged
bands, united together by a very small amount of connective
tissue. The development of smooth muscular tissue is much
greater in the tumour than in the adjacent substance of the
uterus. — From a native female, aged 40, who died of cirrhosis
of the liver and kidneys, &c.

52- Scirrhus of the uterus. The whole of the cervix has been
destroyed, and the adjacent portion of the body of the uterus
has an eroded and fissured appearance. The growth has
extended to the upper part of the vagina, the posterior cul-
de-sac of which has been nearly perforated. There is much
thickening and rigidity of the broad ligaments, and of the
peri-uterine tissues generally.

The structure, microscopically, is seen to consist of nucleated epithelial cells, not
so large or polymorphous as in ordinary cancer of the womb (epithelioma) ;
they are mostly rounded, oval, or angular, and contained in an alveolated
stroma of connective tissue, which, though indistinct in parts, is in others
remarkably well-developed and fibrous.

Presented by Professor D. B. Smith.

53. The uterus and ovaries of a native woman, aged about 40, who
died in hospital. These parts are seen to be infiltrated with
nodules of a pinkish- white soft material, — enkephaloid car-
cinoma. The whole of the cervix presents a ragged, disorganised
condition, — the morbid growth appearing to have originated
here, and to have infiltrated the surrounding structures second-
arily. The ovaries and Fallopian tubes arc matted together, and
fixed to the sides of the uterus.

SEEIKS XIV.]

ENKEPHALOID CANCER.

451)

Under the microscope, both the delicate stroma and characteristic
epithelial cell-elements of this variety of cancer are readily
distinguishable. {See further, “ Medical Post-mortem Records,
vol. 1, 1873, p.288.)

54. Enkephaloid cancer of the uterus. A preparation exhibiting the
pelvic viscera and the kidneys of a native woman, aged. Go.
The morbid changes are as follow: — («) A granular condition
of the kidneys, with dilatation of their pelves and calyces at the
expense of the secreting structure. Dilatation also of the ureters
from obstruction of their vesical terminations by the morbid
growth. ( b ) The urinary bladder, with a large sloughy perfo-
ration of its posterior wall, — the size of a five-shilling piece, by
means of which a direct communication was established with the
vagina, (c) The vagina, with only about an inch of the
anterior portion of its canal entire ; the rest, together with
almost the whole of the uterus, entirely destroyed, i.e., has
softened and sloughed away, (d) The rectum, with a large oval
opening in its anterior wall, about four inches in length by
two in breadth, situated about a finger’s length above the
anus, and communicating with the vagina and the disorganised
remains of the uterus.

The bladder, vagina, and rectum all thus open into each other, owing
to the destruction of the intervening tissues by the cancerous
growth.

Under the microscope, sections taken from different portions of this
mass show all the characters of true enkephaloid carcinoma.

55. The fundus uteri and appendages from a case of carcinoma,—
a native female, aged 45. The anterior half of the uterus
has been completely destroyed, and the substance of the fundus
(remaining) is infiltrated, very soft and pulpy,— rapidly under-
going disintegration. The urinary bladder was laid open, and
a free communication existed between it and the ragged cavity
of the uterus and vagina. The ovaries and Fallopian tubes are
matted together, and fixed to the sides of the uterus. Both the
former showed cancerous infiltration, and the fimbriated extrem-
ity of the right Fallopian tube was expanded into an abscess,
which contained about a teaspoonful of very oltensivc thick
pus.

Sections taken from the softened and disorganising remains of the uterus and
ovaries display, under the microscope, a typical enkephaloid structure;
both stroma and cells are well marked. The former exhibits well-
defined alveoli, which arc crowded with highly granular, fatty, and rapidly
proliferating heteromorphic epithelia. {See further, “Obstetric Post-
mortem Records,” vol. I, 1880, pp. 717-18.)

56. Cancroid of the uterus. A preparation exhibiting the genito-
urinary organs of an Eurasian female, aged 40. The ureters —
particularly the left — are dilated. The urinary bladder is
healthy. The mucous membrane of the upper part of the
vagina is much ulcerated. A narrow ring represents the
remains of the os uteri. It has a cicatricial appearance on its
anterior aspect, but posteriorly has been almost completely

460

CARCINOMA OF THE UTERUS.

[sEBIES XIV.

detached from the cervix, owing to extensive destruction of the
lattei , two or three small soft nodules, in a ragged sloughy
condition, are all the remains of this portion of the uterus. ^On
attempting to remove the uterus (y; ost mortem ) much of its
substance has been unavoidaby torn. Such portions as are
still recognisable, are found infiltrated and soft, and in parts
nearly as thin as brown paper. The fundus uteri alone preserves
its shape, but is also partially softened and ragged.

Both ovaries are small and atrophied, and firmly fixed by infiltrating
material to the fundus uteri. Between the layers of the broad
ligament, on the right side, there is a collection of pus, forming
an abscess the size of a small orange, which extended upwards
to just above the brim of the pelvis, and was adherent to the
peritoneum lining the right iliac fossa. The rectum is healthy.
Neither bladder nor rectum have been perforated, although the
intervening sero-cellular tissue showed evidences of nodular
infiltration and softening:.

Examined microscopically, sections from the cervical and corporeal remains of the
utei us exhibit a carcinomatous structure, consisting1 of alveoli of connect-
ive tissue fiiled with polymorphous nucleated cells of epithelial type.
These cells are more uniform in size, and smaller than in true epithelioma.
They resemble more closely the elements of enkephalaid or scirrhus cancer.
In parts, however, no differentiation into alveoli and cells can be
distinguished, owing to a diffuse cellular infiltration of the fibro-muscular
tissue of the uterus. These cells are highly infiltrated with fat, which is
also abundantly distributed throughout the altered uterine parenchyma,
and greatly obscures the proper fibro-muscular cells.

The characters of the morbid growth are evidently closely allied to, if not identical
with enkephaloid carcinoma.

(See further, “ Obstetric 'Post-mortem Records,” vol. 1, 1877, pp. 353-54.)

57. Epithelioma of the uterus. The os is ragged, widely open, its

edges ulcerated and shreddy. A morbid growth, the size of a
hen’s egg, fills the interior of the uterus ; is somewhat tuber-
culated, and presents a dull yellowish or pinkish-white appearance.
It chiefly involves the posterior superior wall of the fundus, but
also infiltrates the anterior wall, and has extended into the
cervix and os.

Examined microscopically, the structure of the growth is epitheliomatous. The
cell-elements are not so large as those met with in cutaneous epithelial
cancers, but otherwise identical. They are of various shapes, have large
lustrous nuclei ; towards the cervix form burrowing cylinders involving the
mucous follicles and glands, and even exhibit “ nests ” and “ globe-like ”
transformations — a rare occurrence in epitheliomata of the internal or
deep-seated organs of the body.

The specimen was taken from a native female, aged 28, who died in
hospital. Presented by Professor T. E. Charles.

58. “ Uterus and vagina of a European woman of pure descent, who

was admitted into the General Hospital with a large growth,
diagnosed to be malignant, and therefore beyond the reach of
remedy. She died from acute dysentery. Before admission she
had lost much blood from the tumour, a portion of which had

sb&ies xiv.] EPITHELIOMA. 461

begun to break down and fungate The patient presented all
the well marked appearances of malignant cachexia.’’ (Ewart.)

A large fungating mass is seen filling the whole of the vagina. It appar-
ently takes its origin from the posterior lip of the cervix
uteri. In parts it is quite soft and pulpy; in others firm,
opaque-white, and slightly fibrous-looking.

On microscopic examination, the morbid growth presents all the characters of the
ordinary cauliflower tumour or cancer of the uterus, i.e., is epithelioraatous.
In the midst of a very delicate fibrous stroma— only demonstrable in thin
brushed -out sections — large epithelial cells are observed, some round,
others spindle-shaped, stellate, and caudate, with (in most instances) single,
round, or slightly oval nuclei, and a very granular and fatty proto-
plasm. Numerous free nuclei, and much free fat — molecular and granular-
are also distributed throughout such sections No “ nests ” or “ globes ’*
exist. The growth is undoubtedly an epithelioma of the cervix uteri.
— J. P. P. McC. Presented by Dr. J. Ewart, Presidency General Hospital.

59. Epithelial carcinoma of the cervix uteri, removed during life by

the galvanic ecraseur and cautery. The body of the uterus with
the ovaries, and the last lumbar vertebra, —all obtained on the
death of the patient, — are preserved with the morbid growth.
The latter is a fungus-looking, rounded mass, flattened from
before backwards, and measuring about two inches in diameter
by an inch and a half in thickness. Its surface is covered by
close-set papillary outgrowths and small tuberculated excres-
cences. The cancer chiefly involves the anterior lip of the
uterus. A small glass rod has been passed into the much-
contracted cervical canal and separated body of the organ.

Examined microscopically, sections exhibit a true epitheliomatous structure ;
— the superficial portion of the growth consisting of villous masses,
composed of closely-packed, large, epithelial cells, with well-defined
single or double nuclei and nucleoli, no “nests,” and a very scanty
stroma. More deeply, the proper uterine (fibro-muscular) tissues are
found freely infiltrated with nuclei and transitional cell forms. The
blood vessels are large and numerous.

'J he patient was a Bengali female, aged 24, the mother of three
children. The disease was of seven months’ duration. The
operation was performed on the 30th of April, and she died
from exhaustion on the 25th May 1877.

After death, two small circumscribed abscesses were found in each
broad ligament ; and a large psoas abscess, with carious excava-
tion of the last lumbar vertebra on the left side. A very
healthy and clean-looking surfaoe is presented by the uterus
at the site of the amputation (of the cervix), and the body
of the organ is apparently quite free from disease.

Presented by Professor T. E. Charles.

60. Carcinoma of the uterus, involving and almost completely
destroying the cervical portion of the organ, and opening
into the urinary bladder, just above the trigone.

The kidneys and ureters in this case were enormously dilated, and
the former exhibited great expansion of the pelves and
infundibula, with atrophy of the secreting structure. Sections
Horn the diseased remains of the uterus show, under the

462 GRAVID UTERUS. [series xiv.

microscope, the typical structure of epithelioma. The growth
is most luxuriant, and, at the same time, the cell elements
are found undergoing rapid fatty and mucoid metamorphosis.
— From a native woman, aged 40, who died in hospital.

61. “A large pyriform tumour spontaneously expelled from the

uterus. At the time of expulsion it was of a brownish-red
colour, and measured 5| by 3^ inches. Vesicles, varying in
size from a pea to that of a large bean, projected from the
internal surface of a cavity as large as a walnut, found on making
a section in the middle of its widest part. The spongy struc-
ture of the substance of the tumour is plainly shown in this
preparation.” (Ewart.)

This is undoubtedly a uterine mole. It is composed chiefly of coagu-
lated blood, amidst which, traces of decidual membrane (casts
of uterine tubules, &c.,) can be readily distinguished under the
microscope. The upper, basal, and broadest portion of the mass
shows vesicular or “ hydatidiform ” degeneration. The vesicles,
here, vary in size from a pea to a nutmeg, and have thick
mucoid contents, the degeneration affecting, probably, the
placental portion of an aborted ovum.

Presented by Professor Stewart.

62. Hydatidiform degeneration of the ovum. A large vesiculated

mass expelled from the uterus by a native female, aged 22,
in the fourth month of her apparent third gestation. “ She had
twice before aborted.”

(For similar preparations see also Series XVIII.)

63. “ Uterus at five and a half months’ gestation cut open and inverted,

showing the attachment of the placenta and the foetus enclosed
in the bag of membranes, which have been punctured in order to
give exit to the liquor amnii.” (Ewart.)

64. “ Gravid uterus, with contents, at the eighth month of utero-

gestation of a Portuguese, aged 35, who was admitted in a
dying state. She had been suffering from remittent fever and
jaundice for about eight or ten days. She died half an hour after
admission. The section shows in part the attachment of the
placenta. The os uteri is dilated to about the size of a rupee.”
(Ewart.) Presented by Professor T. E. Charles.

65. Uterus with its contents at about the fourth month of gestation.

— Prom an Eurasian woman, aged 24, who died of uraemic coma.

66. Gravid uterus, — the foetus of between the third and fourth month.

From a Hindu widow, aged about 25, who committed suicide by
hanging. “ It is said that she was subject to epileptic fits.” In
the right ovary is a corpus luteum the size of a shelled almond,
with well-defined crenated margins of a deep yellow colour.
Presented by Dr. Mackenzie, Police Surgeon.

67. Congenital absence of one ovary,— the right; the left, with the

Fallopian tube, and the uterus, are exhibited. The uterus is of
normal size, and, as well as the vagina, quite healthy. The ovary
shows, on section, the remains of a false corpus luteum. — From
a native woman, aged 30, who died in hospital of pneumonia.
Presented by Professor D. Ji. Smith.

ABSCESS OF THE OVARY.

463

SERIES XIV.]

68. “ Section of an ovary ” greatly atrophied, and showing

calcareous degeneration of its stroma. (Ewart.)

69. “ Abscess of the right ovarium, which opened into the tundus

of the bladder. The opening made by the advance oi the

abscess has been enlarged by incision at the post mortem
examination, but the irregular and jagged character oi the
margins that bounded the original orifice is distinctly indicated,
and contrasts most obviously with that resulting from a clean
incision.” (Ewart.) Presented by Baboo Juggabandhu Bose.

70. Preparation showing an abscess oi the lett ovary, with acute

suppurative inflammation, dilatation, and _ partial disorgan-
isation of both Fallopian tubes (salpingitis). . The body of
the uterus is enlarged ; its lining membrane thickened, lough,
and villous in appearance, and, at one spot, on the posterior
wall of the fundus, raised into a circumscribed fungus-like
prominence the size of a rupee, which probably indicates the
site of attachment of the placenta. The inflammatory changes
appear to have succeeded an abortion, but no histoiy of the
case is recorded.

71. “ Abscess of the right ovary, adherent to the coecum, and opening

into the rectum after recto-uterine cellulitis.” (Colies.) No
history. Presented by Professor D. B. Smith.

72. The uterus arid ovaries of a native female, a prostitute, aged 23,

who was delivered of a living male child, in the eighth month of
her first pregnancy. Symptoms of acute endometritis supervened
on the third day, followed by those of general peritonitis on the
eighth day. The uterus exhibits an imperfectly contracted and
subinvoluted condition. It is rather larger than the closed hand ;
the walls are thickened and soft ; the lining membrane is shreddy,
in parts sloughy-looking and pus-infiltrated. The right ovary
is much enlarged and swollen. On its posterior aspect was found
a ragged rent, half an inch in length, which communicated with
an abscess cavity occupying the greater part ot the ovarian
tissue. This rupture appeared to have taken place during life,
a portion of the contents of the abscess thereby escaping into
the peritoneal cavity, and provoking that general inflammation ot
the peritoneum to which the patient succumbed. ( See further,
“Obstetric Post-mortem Records,” vol. I, 1875, p. 119-20.)

73. Abscess of the right ovary, which contained more than an ounce

of thick yellow pus. The ovarian tissues are greatly disorgan-
ised, and this organ with the corresponding Fallopian tube
may be observed, fixed to the side and fundus ol the uterus by
firm peritonitic adhesions. On the left side, the same structures
combine to form a cyst, the size of a hen’s egg, with limpid,
serous, fluid contents. The pressure upon the rectum by these
diseased and enlarged ovaries has produced great narrowing of
its canal (as seen in the preparation), about four inches above
the anus. On the proximal side of this constriction the mus-
cular coat of the intestine is considerably hypertrophied, probably
from exaggerated expulsive efforts being required in voiding the

464

CARCINOMA OF THE OVARY.

[SEBIES XIV.

contents ot the bowel (defecation). — From a native woman,
aged 30, who died a few hours after admission into hospital.

74. Cystic fibroma of both ovaries. These organs are considerably

enlarged and lobulated, their capsules thickened. On section,
the structure is firm and elastic, is infiltrated with cystic form-
ations of varying calibre, the largest, in the right ovary, is the
size of a hen’s egg. The uterine walls are also abnormally
thickened, and its cavity enlarged.

On microscopic examination, the structure of the ovarian growths is fibro-cellular,
— well formed white fibrous tissue, plentifully supplied with germinating
nuclei. The normal glandular structures, e.g., the Graafian vesicles, &c.,
are dilated ; their epithelial contents multiplied (proliferated), and under-
going fatty and colloid changes.— From a native female, aged 40.

Presented by Dr. J. Ewart.

75. Carcinoma of the left ovary. The growth is now the size of the

foetal head, and, in the fresh state, was associated with a large
cyst, “ capable of containing 40 ounces of fluid.” This has been
mostly cut away in order to exhibit the solid growth. The latter
has a lobulated outline, is soft in consistency, and on section
presents an alveolated structure. This structure is well dis-
played in microscopic sections, and the alveoli are found filled with
degenerating, heteromorphic, nucleated, epithelial cells. The
stroma (alveolar walls) is also nucleated and fatty. In parts
there is softening and breaking down of the tumour tissue into
more distinctly cyst-like cavities. The uterus is small, and
apparently healthy. No history.

Presented by Professor T. E. Charles.

76. A preparation showing (1) acute dropsy of the Fallopian tubes,

associated with tuberculosis of the peritoneum investing them,
which is covered with minute miliary granulations, and in the
recent state was lividly congested. (2) Both ovaries enlarged,
their parenchyma and capsules similarly infiltrated with grey
tubercle. In the right was found a curdy, yellowish -white
deposit, the size of a walnut, consisting of cheesy, softening,
tuberculous material. There was no general tubercular infiltra-
tion of the peritoneum, but acute basic (cerebral) meningitis,
with a copious exudation of recent lymph, and very minute
scattered tubercles in the pia mater. The cheesy deposit in the
right ovary seems to have been the centre of infection, i.e., the
deposit from which the dissemination of the tubercular growth
proceeded. The patient, a native female, aged 25, died in
hospital. (“Medical Post-mortem Records,” vol. 111,1880,
pp. 563-64.)

77. Atrophy of the uterus, and cystic degeneration of the ovaries.

“ The section of the right ovary shows several small cysts in its
stroma (enlarged Graafian vesicles), and there is a transparent
cyst as large a9 a bean suspended by a pedicle an inch and a
quarter in length, from the broad ligament adjoining the fimbriated
extremity of the right Fallopian tube. Cysts in the stroma
of the left ovary are also distinguished, similar to those existing
in the right one.” (Ewart.)

SERIES XIV.]

OVARIAN CYSTS.

465

78 Preparation showing an “ unilocular cyst of the left ovary, the size

of an orange, and fusiform dilatation of the corresponding Fallopian
fube. — From a subject in the dissecting room.

Presented by Assistant Surgeon Chunder Mohun Ghose, M.B.,
Demonstrator of Anatomy. .

79 “ Two very large ovarian cysts. The larger one is globular, and

measures 14 by 16 inches ; the smaller one is of oval shape,
and is about 12 inches in its long diameter.” (Ewart.) The
large cyst is unilocular, the smaller one multiloculated.

Presented by Dr. John Macpherson.

80. “An enormous unilocular ovarian cyst, which contained pale,
straw-coloured, serous fluid. The wall of the tumoui consists
of two laminae, both together being about four lines in thick-
ness. Its internal surface is regular and smooth.” (Ewart.)

81. “ A dried specimen of multilocular ovarian cyst, the parieties of

which are now of leathery appearance, and about one-twelfth of
. an inch in thickness. It is divided by partitions of similar
consistency and thickness into three large and three smaller
compartments.”

82. A very large multilocular ovarian cyst, with thick leathery walls

and dissepiments. No history.

83. A multilocular serous cyst of the left ovary. It has become

collapsed and shrunken from long immersion in spirit, but, in
the fresh state, was nearly as large as the foetal head. — Found on
post mortem examination of a European woman, aged 51. The
disease was not complained of nor diagnosed during life.

84. Multiloculated cysts of both ovaries. The right is rather larger

than an orange, the left about the size of a duck’s egg. Found
on post mortem examination of a native female, aged about 45,
who died in hospital from carcinoma of the liver.

85. A large ovarian tumour, having a curious dumb-bell shape.

— “ From Gopee, a native female, aged 60 years,— a Hindoo.”

“ The tumour consists of two lobes, — an upper and a lower, — the
upper, having thin transparent walls, is the size of a water-melon,
and traversed on the surface by five or six depressions. The
lower one, larger than the above, has also denser walls, and is
subdivided partially into several compartments. The lower
surface of the tumour was closely adherent to the urinary
bladder.” (Chuckerbutty.)

86. A trilocular cyst connected with the left ovary. The tumour

was as large as the uterus in the sixth month of gestation. The
largest cyst has very massive and thick walls, closely and
remarkably resembling the tissue of the uterus itself, with which,
indeed, they are continuous, both on the anterior and posterior
aspects of the left side of the fundus of this organ. It contained
40 ounces of dark sanguineous fluid and small blood clots.
Its inner surface is remarkably tuberculated, roughened, and
irregular. The second cyst, about the size of two lists, projects
into the first, and extends to the right side of the uterus,
passing behind it and in front of the rectum. It was filled with
about 26 ounces of very thick, dark-brownish, glue-like fluid.

466

PEOLIFEEOUS OVARIAN CYSTS. [series xiv.

Separated by a thin transparent septum from the second cyst
is a third, projecting on the right side of the fundus uteri. It
was intimately adherent to the caecum and lower coils of the
small intestine. It has very delicate walls, and contained about
10 ounces of thin, limpid, straw-coloured, serous fluid. The
cervix and fundus uteri are much elongated ; the uterine cavity
measures about 4-g- inches ; the whole organ was found pushed
considerably to the right of the median line.

The remarkably thick and dense wall of the largest cyst, — measuring from J to 1 of
an inch in diameter, — consists, under the microscope, of very firm white
fibrous tissue, closely meshed, and with broad thick interlacements at the
surface, becoming looser, Fixer, and more abundantly nucleated towards the
interior; throughout freely supplied with blood vessels — both arteries and
veins of large size. No proper uterine tissue, i.e., smooth muscular fibre,
is found.

The patient was a Mahomedan female, a widow, aged 36. The
presence of a tumour in the left side of the abdomen was first
noticed three years prior to her admission into hospital. She had
no children, and had never conceived. The tumour was diagnosed
during life, and aspirated. The operation was followed by general
peritonitis, and resulted in death. ( See further, “ Obstetric
Post-mortem Records, ” vol. I, 1880, pp. 741-42.)

87. “ Unilocular ovarian cyst as large as a man’s head, springing from the

right ovary. At the bottom of the cyst many nodular excrescences
are demonstrated. The left ovary was atrophied.” (Allan Webb’s
Pathologia Inclica , No. 670, p. 290.)

Although the main cyst is unilocular, there are a large number of secondary and
tertiary cysts, forming a series of nest-like growths, springing from the
inner surface of the tumour at its lower part. These project iu tuberous
rounded masses into its cavity. The cyst is therefore not a simple one, but
compound or proliferous. — J. F. P. McC.

88. A proliferous cyst, involving, apparently, the left ovary, and also

intimately blended with the left lateral wall and fundus of the
uterus. The growth is the size of the foetal head. Its walls are
thick and much plicated. It was punctured during life through
the upper wall of the vagina, in the situation now indicated by
a red glass rod. Presented by Professor Allan Webb.

89. A large ovarian tumour with thick leathery walls, and intimately

connected with the fundus uteri. The tumour consists of one
large, somewhat oval-shaped cyst, and a series of smaller cystic
growths budding out from its inner surface. These form
irregularly rounded projections or excrescences, are arranged in
groups or “ nests,” do not intercommunicate, and are filled with
a thick, mucilaginous fluid.

Presented by Professor D. II. Smith.

90. A small, probably congenital cyst of the right ovary, about the
size of a nutmeg. It has a well defined, opaque-white lining
membrane, and is filled with thick sebaceous material, consisting
of fatty epithelial debris, in which is imbedded a small mass of
delicate, long, dark hairs. Taken from a native female, aged 21,
who died in hospital from asthma, &c.

series xiv.] DENTIGEROUS OR DERMOID CYSTS.

467

91. A so-called dermoid or dentigerous cyst of the left ovary, the

size of a walnut. It contained a quantity of soft sabulous
material, some loose dark hair, and a cartilaginous nodule the
size of a pea, &c. Attached to the fimbriated extremity of the
right Fallopian tube, by a slender pedicle an inch in length, is
a 'small grape-like simple cyst. The uterus is enlarged; its
walls thick and vascular ; the organ exhibits all the signs of
subinvolution. — From a native female, aged 28, who died from
exhaustion and diarrhoea six days after premature delivery.
(“Obstetric Post-mortem Records,” vol. I, 1S78, pp. 519-20.)

92. A multilocular and inflamed ovarian cyst, about the size of the

adult head, removed by operation from a European female, aged
45. The cyst-wall is very thick,— in parts not less than one-
third of an inch. The outer portion is firm, tough, and leathery,
consists of well formed fibro-elastic tissue. The inner portion is
soft and laminated, and composed of fibrinous (inflammatory)
material undergoing organisation. In parts it is quite like
granulation-tissue, in others shows incipient fibrillation and
the presence of numerous small capillary vessels. Bands of
similar soft fibrinous material pass in various directions between
the walls of the cyst, dividing it into imperfectly defined and
varying sized loculi. One separate and distinct cyst is found
sessile within the mother-cyst. Its walls are firm, tough, and
fibrous, and it is therefore probably an original, not an in-
flammatory, production. Presented by Professor T. E. Charles.

93. A portion of a large ovarian cyst removed by operation. The

walls are here and there irregularly infiltrated with small
flattened, waxy-white cancerous nodules. The cyst is not
entire ; considerable portions have been torn away in removal.
Both outer and inner surfaces are thickened,— the former from
adventitious adhesions to the abdominal viscera, the latter from
flattened morbid growths, and from fibrinous deposits.

On microscopical examination, the structure of the cyst-wall consists of white
fibrous tissue, with also a good deal of wavy elastic tissue. To these are
superadded the products of (1st) inflammatory changes, — granulation tissue,
with developing capillaries, and young connective (fibrillated) tissue ; and
(2ndly), of infiltrative changes, — deposits or localised growths, consisting,
apparently, of small, nucleated, polymorphous, epithelial cells, — imbedded
in the thickened walls, and contributing largely to the flattened tuberous
excrescences on its inner surface. The cyst is unilocular, but there are
traces of broken down dissepiments in its interior, indicating that this
was not its original condition. It had developed from the left ovary.
The epithelial new formations are probably malignant, i.e., scirrhus in
character.

“ The patient was a European female, aged 32, married, with one
child, born three years ago. First noticed the enlargement of
her abdomen ten months ago ; it has gradually assumed its
present size. Menstruation has been regular, coming on every
three weeks.

Operation.— An incision about 4| inches long was made in the mesial
line, from just below the umbilicus downwards. The cyst was
punctured with Spencer Well’s trocar and partially emptied,

468

OVARIOTOMY.

[series XIV.

about 700 ounces of dark-reddisli fluid evacuated. Very firm
adhesions were found between portions of the cyst-wall and the
abdominal wall and viscera, in attempting to separate which,
many fragments of the cyst-wall were broken away. There were
numerous nodular (apparently scirrhus) growths in the cyst- wall,
and matting it to the left kidney, spleen, &c. The right ovary
was found occupied by similar growths and multilocular cysts.
The patient died from peritonitis 48 hours after the operation.”
Presented by Professor T. E. Charles.

94. A large ovarian cyst removed by abdominal section, from a native
(Hindu) female, aged 26. The cyst contained 352 ounces of
fluid, besides the large semi-solid growth now exhibited within its
walls. It had developed from the right ovary, and was of three
years’ duration. The abdomen was uniformly enlarged during
life ; there was no history of uterine haemorrhage ; there bad been
no menstruation “ for the last 18 months.”

The tumour was one very favourable for operation, as the woman was healthy-
looking and fairly robust, and there appeared to be very few adhesions to
the surrounding parts. The latter was confirmed at the time of oper-
ation,— almost the only adhesions being situated low down, between the cyst
and the anterior abdominal wall, and between it and the urinary bladder.
In attempting to separate them Trom the last mentioned viscus, it (the
bladder) was accidentally lacerated. The patient bore the operation well,
and was doing well for about 24 hours, but extravasation of urine taking
place from the injured bladder set up general peritonitis, which proved fatal.

The cyst-wall is of leathery consistency, and from ^ to ^ of an inch
in thickness. It is composed of white fibrous and elastic tissue.
The inner surface is polished and glistening, but not smooth.
It is corrugated, and irregularly and softly tuberculated, from the
presence of localised spots of mucoid softening and proliferous
growth. These constitute slightly projecting flattened nodules,
and cystic transformations of the same character. The main
cyst, however, is unilocular. Developing into it, on one side,
is a semi-solid mass, as large as two fists, the free surface
of which is lobulated. This mass appears to be the greatly
hypertrophied and degenerate ovary, around which the cyst has
grown to its present enormous dimensions. This semi-solid
body is observed on section to consist of a series of round
or oval cystic expansions, filled with thick opaque mucoid
material. They vary in size from that of a pea to that of a
hen’s egg, and, as a rule, do not intercommunicate.

Under the microscope, the walls of these cystic growths are seen to be com-
posed of well-formed connective tissue— white and glistening ; the inner
surface is lined by epithelium, which in some is distinctly columnar, in
others, flattened. The contents have the usual appearance of mucoid
material, and, suspended in it, are found small masses of cylindriform or
columnar epithelium, or of small round nucleated cells, or the same two
varieties of cell elements free. It is very evident, therefore, that the
large intra-cystic mass is, as was suspected, the degenerate ovary, the
cystic transformation having taken place probably at the expense of the
Graafian follicles of this body, with subsequent mucoid metamorphosis.
(See further, “ Obstetric Post-mortem Records,” vol. I, 1880, pp. 735-36.)
Presented by Professor R. Harvey.

SERIES XIV.]

DROPSY OP FALLOPIAN TUBES.

460

95. The left ovary of a native female, aged 20, who died from

puerperal eclampsia, showing a true “ corpus luteum.”

96. “ Ovaries of a woman at the eighth month of utero-gestation, who

died after parturition. Showing sections of corpora lutea, indicated
by small glass crosses.” (Ewart.) Presented by Mr. Sakes.

97. The uterus, ovaries, &c., of a native female, aged 35, who died

from cholera, and aborted during the attack. The left ovary
contains a large, well-defined, stellate corpus luteum of preg-
nancy. The right ovary is cystic and enlarged. Growing from
the left broad ligament is a pediculated cyst, the size of a
pigeon’s egg, filled with gelatinous, amber-coloured fluid.

98. The uterus and appendages. Both Fallopian tubes are dilated,

and their lining membrane rough and corrugated. The uterus
is a little hypertrophied ; its walls soft, the mucous membrane
granular and highly vascular. — “From a patient who died
from excessive haemorrhage from the uterus.”

Presented by Dr. Green.

99. Preparation showing dropsy of the Fallopian tubes, particularly

of the left. Their fimbriated extremities present a con-
voluted, sausage-like, highly distended, and swollen condition,
and contained limpid, clear, serous fluid. The walls of these
structures are stretched, thinned, and almost transparent. Both
ovaries are atrophied. — Found on post mortem examination
of the body of a native female, aged 25, who died from pulmo-
nary phthisis. No symptoms of the tubal disease during
life. (“ Medical Post-mortem Records,” vol. II, 1878, pp. 847-48.)

100. Great dilatation and contortion of the Fallopian tubes, the channels
of which were found completely filled with very thick curdy
or cheesy material. The peritoneum investing these structures
was brightly injected and highly vascular, and there are old
inflammatory adhesions between them and the ovaries on either
side of the uterus. The patient, a native female, aged about
3G, died from acute tubercular phthisis. ( See further, “ Medical
Post-mortem Records,” vol. Ill, 1880, pp. G17-18.)

101. The uterus, Fallopian tubes, and ovaries of a native woman, a
prostitute, admitted into hospital with symptoms of acute peri-
tonitis, of which she died. On post mortem examination, there
was found intense congestion and matting together of the pelvic
tissues and contents. The Fallopian tubes showed livid, pur-
plish discolouration, were greatly enlarged and dilated, and on
incision, about half an ounce of pus escaped from each. The
uterus is not enlarged, and exhibits no material morbid alteration.
The left ovary contained a very large, dark, recent blood-
coagulum. The right is atrophied. The dilated and distorted
condition of the Fallopian tubes, and the inflammatory thicken-
ing of their walls, are well illustrated in the preparation.

102. A cyst the size of a hen’s egg, with thick leathery walls, devel-
oped between the layers of the right broad ligament. The
ovary and Fallopian tube on this side are much flattened, and
adherent to the upper portion of the cyst.

Presented by Mr. P. A. Minas.

470 LACERATION OF THE VAGINA. [semes tir.

103. A small fibroma attached to the left broad ligament, but other-
wise floating freely in the pelvic cavity. — Found on post mortem
examination of a native female, aged 45, who died from chronic
diarrhoea.

The tumour is the size of a betel-nut ; consists, under the microscope,
of fine white fibrous tissue, with also a considerable amount of
wavy elastic filaments. A polypoid myoma, the size of a pea,
is seen developing from the anterior wall of the fundus uteri.

104. “ Uterus, vagina, and greater portion of the external parts of
generation of a young Mahomedan female, displaying laceration
of the perineum and a considerable portion of the vaginal sheath,
the effect of violence done to the parts on the first act of cop-
ulation, by which a violent haemorrhage, to the destruction of the
child (barely 12 years old), was occasioned. The uterus and
parts concerned are diminutive and undeveloped, as might
naturally be expected at that tender age, and before the process
of menstruation had been established. The coagulum at the
bottom of the jar was removed from the vagina after death.

The sudden and unlooked for death of the child on the first night of her marriage,
and the unaccountable quantity of blood found beneath the bed, and upon
her linen, led to the suspicion of unfair means having been resorted to for
her destruction. The body having accordingly been exhumed to ascertain
the cause of death, the vagina and perineum were found ruptured in the
manner above described, and as represented in the preparation. But as
a judicial enquiry elicited no facts or circumstances tending to show that
any unlawful means had been made use of by the husband to effect his
purpose, and his generative organs presenting nothing unusual to account
for the appearances, while the immediate cause of her death was satisfac-
torily explained by loss of blood from the vagina, it may be considered a
case of extreme preternatural weakness or laxity of the genital system of
the female, and of very rare occurrence, for the common practice of Eastern
nations in forcin'? sexual intercourse upon children of even earlier years
than the subject of the present enquiry would not appear to be attended
with similar disastrous consequences.” (Allan Webb. Pathologia Indica,
No. 204, p. 285.)

105. The vagina and uterus from a case of instrumental labor (cranio-
tomy and exvisceration). The preparation shows a greatly
lacerated condition of the vagina, with a large rent in its posteri-
or wall opening into the rectum. The lips of the uterus are
enormously swollen and torn. The uterus itself is rather
larger than two fists. Its walls are exceedingly massive and
thick, measuring from two to two and a half inches at the
fundus. Its inner surface is shreddy, and was deeply blood-
stained. The left ovary contains a true corpus luteum of
pregnancy. The thickening of the uterine walls is quite abnor-
mal, and apparently indicates a condition of chronic myo-metritis,
or slow and interstitial hypertrophy of all the uterine tissues.

The patient was a Bengali widow, aged 23. It was her second pregnancy. The
first labor had taken place 18 months previously ; the foetus was dead
and extracted by native midwives with great difficulty, and after much
laceration of the soft parts, but no instruments were. used. On this
occasion (second labor) the vagina was found to end in a kind ot cul-de-sac
two inches from the vulva. At the distal end of tnis pouch was a small

SERIES XIV.]

RECTO- VAGINAL FISTULA.

471

orifice, through which a uterine sound could just he passed. This was
dilated with laminaria and tents of sola-pith, but, when a freer examin-
ation could be made, the pelvis itself was found to be much contracted.
Craniotomy was therefore performed, and even then, owing to the contracted
condition of the vagina and the numerous cicatricial bands passing from
side to side between its walls, great difficulty was experienced m delivering
the woman. Several of the latter (bands) had to be freely incised before
the whole of the foetus was brought away— piecemeal. The patient died
16 hours after delivery. ( See further, “ Obstetric Post-mortem Records,
vol. I, 1879, pp. 625-26.)

106 The pelvis from the above case, showing the contraction at the

outlet, which increased the difficulty of delivering the patient
The measurements are (1) oblique conjugate 4* inches; (2)
antero-posterior at outlet 3f inches ; (3) transverse at outlet 3T

inches. . . ,,

107. “ Specimen showing a recto-vaginal fistula. The opening in the

rectum begins about half an inch within the verge of the anus,
and that of the posterior wall of the vagina is about the same
distance from the froenum. There is much thickening ol the
parts about the fistula, which is indicated by the insertion of a
red o-lass rod. There is a small globular cyst attached to the left
ovary, as large as a hen’s egg. (Ewart.) No liEtoiy.

Presented by Dr. Chuckerbutty.

108 Complete prolapsus of tho vagina, removed post mortem from a
native female, aged 35, who died of acute dysentery. The in-
tecrumental-like transformation of the chronically everted mucous
membrane is well demonstrated. The urinary bladder has been
opened, and may be seen to the left of the uterus ; the latter is
greatly elongated, and its cavity narrowed.

109 “ Vagina and os uteri largely covered over with superficial and
deep ulcers. The latter are circular, having completely pene-
trated the mucous membrane.” (Allan Webb.) . No history.

HQ A polypoid fibroma of the vagina. The preparation exhibits (1)
the uterus much enlarged, and its walls greatly thickened. (2)
The urinary bladder healthy, and the urethral canal patent. (3)
The vagina large and capacious. Growing from its anterior
wall, near the orifice, is a polypoid tumour as large as a potato.
The pedicle is short and thick ; the fundus superficially ulcerated,
probably from exposure, as the tumour must have projected
external to the vulva. It is invested by the mucous membrane
common to or continuous with that of the vagina. The tumoui
tissue is firm, and fibrous-looking on section, consists of well
formed fibrous tissue, the fasciculi of which decussate in various
directions, are intermixed with elastic filaments, and contain also
smooth muscular tissue, fat granules, Ac. : in fact, the structuie
of the polypus is strictly homologous with that of the vaginal
wall or matrix from which it has developed. No history.

Ill “ Preparation showing an almost hermaphrodite condition of the
organs of generation in a foetus. Female organs predomimate.
There arc ovaries, Fallopian tubes, small uterus, vagina, hymen
with female urethra. Above there is a penis (clitoris), with
prepuce and glans, but there is no communication with the

472 ELEPHANTIASIS OF THE LABIA. [series xiv*

bladder. What appears to be the scrotum is probably the
exaggerated labia maj ora.” (Ewart.)*

Webb’s PatJioloyia Indica , No. 57 6, p. 285.

112. “ Extensive sloughing ulceration of the left labium, and upper
part of the pubis on the right side, from a young native girl who
suffered from spleen disease, and had mercury given her for the
cure of syphilis.” (Ewart.) Presented by R. W. Righton, Esq.

113. “ Elephantoid hypertrophy of the labia minora, and of the
clitoris.” (Ewart.)

Presented by Assistant Surgeon Kasi Nath Dutt.

114. “ Elephantoid hypertrophy of the labia majora and clitoris.”
(Ewart.) Presented by Professor S. B. Partridge.

115. A similar specimen, but of much larger size. The hypertrophic
growths of the labia are ovoid in shape, very massive, and dense ;
that involving the clitoris and labia minora is more irregular,
much lobulated, and more soft and succulent in consistency.
Presented by Professor Harrison.

116. “ Elephantiasis of the labia, nymphse, and clitoris of a native
woman, aged 30. It weighed 29 ounces when removed, and was
of two years’ standing.” (Ewart.)

Presented by Professor S. B Partridge.

117. Elephantiasis of the left labium, associated with warty or con-
dylomatous growths around the anus. These growths were
removed by operation at the same time, and are exhibited
together. The labial tumour was of six years’ duration. The
patient, a native female (widow), aged 30, had suffered from
gonorrhoea, but gave no history of syphilis. “ Her husband is
said to have had an elephantoid scrotum. She has suffered from
periodic fever — latterly every month ; each attack has been
accompanied by painful swelling of the hypertrophied labium.”
Presented by Professor J. A. Purefoy Colies.

118. Elephantiasis of the clitoris and labia majora, — from a native
woman, aged 30, a public prostitute. The growths are said to
have been of one year’s duration. There was no hereditary
history. The woman was born at Allahabad, and had lived
since the age of 10 at “ Soora,” an inland village three miles
east of Calcutta. Has suffered a good deal from malarial fever ;
and, since the commencement of the growth, i.e.} last twelve
months, has, as a rule, had ague twice a month. The disease
first showed itself as a small wart or pimple between the clitoris
and right labium. It has attained present dimensions gradually,
and is described as becoming swollen and painful with each
attack of fever. The hypertrophied clitoris and labia exhibit,
very characteristically, the general and microscopic structure
of “ elephantoid ” growths. The former is the size of a small
orange, constricted at its base, and marked here by a deep
grove of ulceration. The latter (labia) have a lobulated and

• The only marked peculiarity in this preparation is the abnormal size and penis-like
character of the clitoris ; all the other genital organs are clearly ihose of a female foetus.—
J. F. P. Mc(J.

SERIES XIV.]

CONDYLOMATA.

4,73

119.

120.

121.

122.

123.

124.

125.

126.

warty appearance, and a somewhat piebald colour from in-
equality in distribution of the integumental pigment.

Presented by Professor J. A. P. Codes.

Elephantoid hypertrophy of the labia and clitoris.— From a
Hindu woman, aged 25. The right labium is more enlarged
than the left. All the diseased parts show a very characteristic
tuberculated and thickened condition of the integumental
structures. The growth is of seven years’ duration. It com-
menced,— according to the patient’s statement, altei soit
chancre. “ On the healing of the sores the labia began to enlarge
and thicken ; but she has also had frequent attacks of intermit-
tent (malarial) fever, and, at these times, there has been noticed
painful swelling of the affected parts. She has lived chiefly at
Burdwan.” Presented by Professor H. C. Cutcliffe.

A portion of an enormous elephantoid growth of the vulva.
The clitoris and labia minora are only preserved ; the labia
majora were also affected, and the whole mass when removed
weighed 7ft 10 ounces. The patient was a native female,
aged about 30 ; a resident of Bankura. There was a distinct
history of repeated attacks of fever, associated with lymph-
ano-itic swellings in the groins and axilla?. The present growth
was of about 12 years’ duration. It has a very characteristic
lobulated and tuberculated appearance.

Presented by Professor K. McLeod.

“ Condylomatous excrescences springing from the labia pudendi.”
(Ewart.)

“ Condylomata upon the clitoris and nymphse.” (Ewart.)

“ Condylomata upon the labia pudendi.” (Ewart.)

“ Extensive warty, pendulous tumours ” (condylomata) “ of the
nymphse and clitoris of a native woman. That of the right
nympha particularly large, and superficially ulcerated on its
vaginal aspect.” (Colies.) Around the lower half cf the orifice
of the vagina, and encircling the anal margin, there are similar
but smaller growths. They are all soft and succulent in con-
sistency, deeply fissured ; have narrow conjoined pedicles, and
expanded, flattened, tuberous free extremities.

Syphilitic warty growths — condjdomata —of eight months’
duration, removed by operation from the skin around the margin
of the anus of a native female, aged 2 2.

Presented by Assistant Surgeon itamnarain Dass.

A condylomatous growth affecting the clitoris and labia minora
of a young native female, a prostitute. It first appeared as
a small pea-like nodule upon the prepuce of the clitoris.
“ The patient had syphilis about a year ago, and has suffered much
from pruritus vulva?.” The growth is the size of one s fist.
It is highly lobulated. The surface of the lobules is smooth,
their divisions shallow. Individual lobules vary in size from
a millet-seed to a walnut. To the feel their substance is soft,

474 CONDYLOMA. [seeies xiv.

spongy, and elastic ; on section presents a yellowish-white or
creamy colour, and fibro-adipase structure.

Under the microscope, there is observed (1) very slight increase of the cuticular
layer; (2) more change in the papillary layer — the papillae well marked,
large, extending deeper into the cutis vera than is normal; (3) most
alteration in the deeper strata of the cutis vera. The great bulk of the
tumour seems to be composed of exuberant and thickened connective or
fibrous tissue, freely infiltrated with a small, round, nuclear or corpuscular
growth, the individual elements of which have the appearance and size of
ordinai-y leucocytes. This is most abundant around the cross and longi-
tudinal sections of the arteries. The latter are large, and their accompanying
veins dilated. There is a resemblance, therefore, in the general structure
of the growth to “ elepliautoid ” tumours; the cellular infiltration, however,
seems to be more luxuriant, and the papillary and epithelial layers of the
skin less affected. The highly cellular and vascular character of the
growth are its chief and distinguishing peculiarities, and it thus approaches
in structure more nearly to syphilitic infiltrations of the skin. The
probabilities are, therefore, that this is a condylomatous tumour — that
term being understood to represent an overgrowth of already existing parts
under a specific irritation. The structure does not, when minutely com-
pared, resemble simple elephantoid growths of these parts (labia)
Presented by Professor T. E. Charles.

CATALOGUE

OP THE

PATHOLOGICAL MUSEUM,
MEDICAL COLLEGE, CALCUTTA.

PAET 1 1 1 .

DISEASES OF THE MAMMARY GLAND, AND
DISEASES OF THE ORGANS OF SPECIAL
SENSE, AND OF THE SKIN.

Series XV and XVI.

SERIES XV.]

INDEX.

477

Series XV.

DISEASES OF THE MAMMARY GLAND.

INDEX TO THE SERIES.

A. — FEMALE BREAST—

1. — TUMOURS AND MORBID GROWTHS — *

(a) Fibroma, 1.

(b) Sarcoma, 2, 3, 4, 5.

(d) Carcinoma: —

i. Scirrhus, 10, 11, 12, 13, 14, 15, 16, 17, 18.

ii. Enkephaloid, 19, 20, 21.

iii. Colloid, 22.

iv. Epithelioma, 23, 24.

(e) Cyst, 25.

B. -MALE BREAST—

1. — Tumours and morbid growths : —

{a) Fibroma, 26.

(b) Carcinoma, 27.

( c ) Sarcoma, 28.

1. A tumour involving the right mamma of a native woman, aged
20. It has ulcerated at one part through the skin, — over a space
as large as the palm of the hand. The nipple is not implicated,
though somewhat depressed or retracted. The tumour, on
section, presents a lobulated or nodulated appearance, — the lobules
varying in size from that of a pigeon’s egg to that of a
potato. Their structure is firm, but elastic ; smooth and fibrous-
looking on incision, and of a yellowish or pinkish-white colour.

Under the microscope it is found almost purely fibrous. Some glandular tissue is
certainly met with, but evidently in an atrophic condition, — the acini small
and compressed, the tubules obliterated, their lining epithelium shrivelled
and fatty-looking. The growth has been periacinous and peritubular in
character. I he connective tissue, not the gland structure of the mamma, has
been affected, and has undergone enormous fibrous development. This fibrous
tissue is well formed, sparingly nucleated, and possesses but few large blood-
vessels. By its progressive increase and growth, pressure has been exercised
upon the proper secreting structure, and has led to its atrophy. The
tumour is a pure fibroma ; not an adenoma.

* See also Series XVII.

478

SARCOMA OF THE MAMMA.

[series XV.

The patient was a married woman, had one child, born four years ago,
which, however, died soon after birth. She is said to have con-
tracted syphilis from her husband. There was no history of
injury or blow, &c. She was anaemic and weakly -looking, and
had suffered considerably from malarial fever.

Presented by Professor K. McLeod.

2. Sarcoma of the mamma. The growth with the gland forms a mass
the size of two fists. It affects only the superficial portion of the
latter; the basal part of the breast remains healthy. The
skin is ulcerated in two situations, and through these the tumour
tissue protrudes in the form of large, soft, globular, fungoid-
looking masses, — cne the size of a small orange, the other of a
hen’s egg. At the upper part of the former the nipple may be
seen.

Microscopic examination of tlie growth shows its structure to be highly cellular;

the cells, mostly rounded and uniform in size, vary from -nr to to jj-pUo
of an inch. A few are spindle-shaped. The larger cells contain distinct
large nuclei, usually single. There is no stroma, and only a scanty granu-
lar, or faintly -fibrillated intercellular substance. The consistency through-
out is soft. The tumour is, therefore, a large round-celled or alveolar
sarcoma.

The patient was a native female, aged 50. “ The disease was of three

months’ duration, and some of the axillary glands were affected
and removed at the same time as the breast.”

Presented by Professor S. B. Partridge.

3. A large malignant tumour of the left mamma. From a Hindu

female, aged about 45. “ It commenced on the anterior aspect

of the breast, a little to the left of the nipple, three months
ago.” The present dimensions are (1) circumference, laterally, 28
inches ; (2) antero-posterior circumference, 24 inches ; (3) weight
immediately after operation, 10 pounds. “ The patient made a
good recovery.”

The tumour involves the whole gland ; it is intimately adherent to the
skin, largely lobulated in outline and also on section. The nipple
is not retracted.

Under the microscope the structure consists of small spindle-shaped and
round nucleated cells, closely and densely massed together. No
stroma. Is therefore sarcomatous in character.

Presented by Assistant Surgeon Bam Chunder Sen, Bhowanipore.

4. The right breast amputated for a tumour supposed to be of can*

cerous nature. From a native female aged 27. The growth is
said to have been of five months’ duration.

The tumour is about the size of the foetal head. A portion of the
skin, including the nipple, which has been removed with it,
appears to be healthy ; the latter unretracted. The growth
is ovoid in shape, but flattened at the base, which lested
upon the pectoral muscles, — fragments of which can be traced
still attached to this part. No distinct capsule exists. Out-
line undulating rather than lobulated. Substance soft and
succulent. On section, the tumour has an opaque-white or
pinkish-white appearance. Is here and there lobulated and

SERIES XV.]

SARCOMA OP THE MAMMA.

•179

fibrous-looking from the existence of portions of gland structure
not thoroughly involved. The principal mass, however, has a uni-
formly smooth, or hut slightly granular, cut surface. In parts is
quite pulpy, and has a sanguineous tinge, — the results of second-
ary metamorphoses.

Microscopic structure. Fine sections of the tumour present a densely eelluhir struc-
ture, and, even after careful brushing out under water, little or no trace
of any intercellular material is found. The proper gland tissue (acini
and tubules) has almost completely disappeared. The cells are round or
oval, and very uniformly so; in size vary from that of a white blood-
corpuscle to elements three or four times this size. They are finely
granular, and possess from one to four large, well defined nuclei. In
the smaller cells the nucleus occupies almost the whole of the protoplasm.
Between the cells soft, finely granular, amorphous material can here aud
there be detected, and in some sections a certain amount of fibrillated
connective tissue — apparently the remains of the original gland tissue.
The tumour is undoubtedly a sarcoma, and a well-marked example of the
large round or oval-celled (alveolar) variety.

With this tumour is also preserved the recurrent growth , which
appeared, about two months after amputation, in the cicatrix left
by that operation, and which showed, on microscopic examin-
ation, distinct evidences of similar (sarcomatous) structure to that
of the primary tumour. It was also removed by operation. A
second recurrence, however, took place, and large fungoid masses
appeared along and in the neighbourhood of the cicatrices.
Secondary or metastatic developments now occurred also in the
lungs and liver, and the patient died worn out and exhausted by
the disease. Presented by Professor S. B. Partridge.

5. Malignant (sarcomatous) tumour of the left breast. From a native

(Mahomedan) female, aged about 40. It was of very rapid
growth, having attained present dimensions in about seven
months. “ The breast was twice lanced for supposed abscess,
each operation only accelerating the growth of the tumour.”
The latter consists of a large lobulated and fungus-looking mass,
the size of the closed hand. It appears to involve the whole of
the mamma, and to have deeply infiltrated the subjacent cellular
tissue and nearest lymphatic glands. Over the greater part of
its surface the skin has given way — been ulcerated. No trace of
the nipple can be discovered ; its position is marked by a kind
of crucial depressed cicatrix. On section, the tumour is seen to
be greatly disorganised and softened at its central and basal
portions ; towards the upper part and circumference is of greater
consistency, but is still soft and succulent, and of an opaque-
white, more or less homogeneous appearance.

Under the microscope, the structure is densely cellular — the cell elements being
about twice the size of blood-corpuscles, round or spindle-shaped, mono -nucleat-
ed and granular. Very little intercellular substance— and that amorphous
in character — exists, aud no true stroma. The tumour is a true sarcoma,
not a eancerous growth.

Presented by Professor W. J. Palmer.

6. Chronic mammary glandular tumour (adenoma) “ removed from the

right breast of a native woman about GO years of age. It
weighed four pounds thirteen ounces. The patient died from

480 ADENOMA OE THE MAMMA. [seeies xv.

shock, and fatty degeneration of the heart. The liver was also
fatty and soft. The other viscera were healthy.”

Presented by Professor J. Fayrer.

7. Cystic adenoma of the mamma. From a lady, aged 52. “ It had

been of slow growth and painless for several years, but within
the last two years had increased rapidly and occasioned much
distress.” The nipple is seen a little retracted. The tumour-
substance is semi-solid and elastic to the feel, and on section is
seen to consist cf a series of cystic dilatations, — the largest about
the size of a walnut. Their contents were varied. Some were
found filled with dark, grumous, bloody-looking fluid ; others with
thick, glue-like, brown, greenish-brown, or chocolate coloured
material ; and others again, have semi-solid intracystic growths,
developing, as it were, from their walls. These growths present,
under the microscope, only an exaggerated condition of the nor-
mal glandular structure of the mamma — the lactiferous tubules
hypertrophied and filled with epithelial cells in a state of fatty
degeneration. No cancerous or other malignant structure.
Presented by Dr. J. Ewart.

8. Amputation of the right mamma for a large adenomatous tumour

involving the whole gland. The patient was a native female,
aged about 45. The tumour is about the size of a cocoanut.
The nipple is unaffected and unretracted. On one side of it are
two large ulcerations of the adjacent skin, — each about the size
of the palm of the hand. The outline of the growth is irregu-
larly and deeply lohulated, a condition which is preserved when
sections are made through it. The consistency is firm. The
cut surface is white and glistening, and an innumerable series
of cyst-like expansions or acini are brought into view. These
arc filled with soft semi-solid or pultaceous contents. In most
instances these contents assume a fungating appearance, which,
moreover, is especially marked towards the periphery of the
gland, — here huge, tuherculated, fungoid growths are seen pro-
jected from the main mass of the tumour, and protrude from the
ulcers, above described, at its surface. A tolerably well-defined
capsule of connective tissue invests the tumour, and there is no
evidence of infiltration of the surrounding parts.

Under the microscope, the normal acinous structure of the gland is seen to persist,
but the individual acini are enlarged and distorted,— expanded evidently
by an intramural growth of epithelial cells of the ordinary glandular
type. The acini are separated by bands of delicate connective tissue, into
which the cell growth does not extend. Many of the intra-acinous cells are
highly fatty, and so also is much of the inter-acinous and intertubular
tissue. The whole gland does not appear to be equally affected — some parts
presenting an almost normal appearance. The exaggerated and morbid
growth is most marked in a portion, the size of an orange, situated just
beneath the cutaneous ulceration. The tumour altogether is a very typical
and well-marked example of acinous adenoma of the mamma.

9. Cystic adenoma of the left breast. From a native female, a widow,
aged 30. “ The tumour is of fourteen months’ growth, and was

quite painless until the last month j and latterly the axillary
glands have become enlarged.”

SEBIES XV.]

SCIRE II US OF THE MAMMA.

481

The morbid growth, involving apparently the whole gland, forms a
mass about the size of the adult head. It is broadly* tabu-
lated and cystic to the feel. On section, a large portion of
the central part of the tumour is seen hollowed out into a cyst,
larger than an orange, which contained much broken-down,
softened, cheesy, or sebaceous material. Several smaller cysts
surround this large one. The circumference of the tumour is
more solid, and has a very characteristic adenomatous appearance ;
consists of a series of large acini or loculi occupied by solid,
vegetating contents. These acini are of all sizes, the largest as
big as a nutmeg, the smallest about that of a pea. There is a
firm fibrous capsule investing the whole tumour.

On microscopical examination, the structure of the growth consists of dilated
and enlarged acini bound together by loose connective tissue (plentifully
infiltrated with nuclei and fat granules) and filled with degenerating fatty
epithelium. There is no heteromorphic cell development, &c. The tumour
is therefore an adenoma or chronic mammary glandular tumour , and is only
peculiar from the circumstance of its having undergone so great softening
(fatty apparently) aud pseudo-cystic transformation towards its centre.

10. Scirrhus of the mamma. The whole of the breast and a portion

of the superjacent skin have been excised en masse. The nipple
is retracted and surrounded by a slightly raised and thickened
areola. There is no ulceration of the integumental structures.
On section, the gland has a very dense, hard, almost stony
consistency, and a yellowish-white, faintly-fibrous appearance.

On microscopic examination, both the fibrous stroma and characteristic
cells of scirrhus cancer are well seen ; the former is particularly
thick and small-meshed.

11. Preparation showing carcinoma of the left breast, with recurrence

of the growth in the cicatrix of the operation after an interval
of about a month. “ From a female patient (Goya). Duration
six months.” In the first operation the whole of the gland was
removed. It has a yellowish-white appearance on section and
is very dense and firm. The structure of the morbid growth
is that of true scirrhus, — both stroma and epithelial elements
being well developed. In the recurrent nodule the structure is
equally typical, but the consistency much softer. It has develop-
ed at one extremity of the cicatrix left by the first operation.
Presented by Professor J. Fayrer.

12. “ Scirrhus of the breast. From a native female, aged 42. Removed

by Dr. Fayrer on the 21st January 1865. Contains a fibrous
stroma and nucleated cells. Disease returned and Droved fatal
in 1866.” (Colies.) 1 al

13. “Mamma of a native woman, removed for scirrhus cancer of

two years’ standing. The incipient ulceration round the nipple
was the result of the application of leeches by advice of a native
kobraj.

Microscopic examination showed a matrix consisting almost wholly of
yellow elastic tissue, containing in its interstices numerous fl-i(-
polygonal cells, with granular contents.” (Colies.)

SCIRRHUS OF THE MAMMA. [series xv.

remarkably hard and nodulated condition of the growth is well
displayed in this preparation.

“ Scirrhus tumour of female breast. Its section was dense, and cut
like gristle or cartilage. Many cells of oval character, nucleated,
large, some caudate, some irregular, and some in a state of fatty
degeneration, were found on microscopic examination, as also
a great deal of fibrous tissue. The tumour had begun to fungate
through the skin.” (Ewart.)

Scirrhus of the mamma ; from a native female, aged 45. The
nipple is remarkably retracted and ulcerated. The growth
appears to involve the whole of a somewhat atrophied gland.

It is extremely firm and hard. On section, has a yellowish-white
fibrous appearance, radiating processes from which can be traced
into the surrounding adipose tissue.

The structure, microscopically, is typical. The stroma very dense, and, just below
the nipple, quite cicatricial in character. At the periphery of the growth
the cell elements are moderately large, epithelioid, nucleated, and granular.

The infiltration of the surrounding non -glandular tissue is also very distinct.

The lymph-glands in the axilla were indurated and cancerous : several
were removed at the same time that the breast was amputated.

. Presented by Professor J. Fayrer.

16. Scir rhus of the left breast, — said to be a growth of only six

weeks’ duration.

This is a small, cicatricial-like nodule, the size of a nutmeg, sur-
rounded by much soft, fatty tissue. (When excised, the whole
mass was about the size of an orange, but much of the sur-
rounding adipose tissue has been removed). The growth
proper has a dense white, slightly fibrous appearance, with a j
stellate margin, sending out processes or prolongations into the
surrounding adipose tissue. It is firm-cutting like cartilage.

On scraping the cut surface, a small quantity of highly fatty
(milky) juice is obtained, in which, however, a few epithelial cells
with large nuclei can bo seen.

When sections are placed under the microscope, the structure is found to be densely
fibroid, but clefts or spaces — scarcely amounting to alveoli— also exist,
which are filled with true glandular epithelium. These cells are rounded
or angular, only a few caudate; the majority have single large nuclei; all
are granular from fatty metamorphosis. The epithelial proliferation is not
at all abundant, and the alveolar stroma imperfect— conditions remarkable
if the growth was, as is seated, of only six weeks’ duration.

The tumour was removed from a European female, aged G5.

Presented by Dr. E. Lawrie.

17. Scirrhus of the left breast, removed by operation, “ from an

East Indian female, aged 28 (?). The tumour is of ten months’*
duration. No hereditary history of cancer. A chain of lymphatic
glands in the axilla were enlarged. The tumour had been very
painful during the last four months. The patient is healthy-
looking.”

The excised mamma with adjacent adipose tissue forms a mass the
size of a large orange. The amount of fat surrounding the

482

The

14.

15.

series XV.] ENKEPHALOID CARCINOMA. 483

gland is very considerable ; the latter is shrunken and atrophied.
On section, it is very dense, firm, and compact, — cuts like
cartilage ; has a yellowish-white colour, and fibrous appearance.
The nipple is considerably retracted. There is no ulceration of
the superjacent skin, a portion of which has been removed
with the diseased gland.

Under the microscope, a typically scirrhus structure is found, the stroma
being particularly well developed, — formed of broad bands of
nucleated connective tissue, leaving small alveolar spaces by
their interdigitations, and these occupied by epithelioid, nucleated,
polymorphous (cancer) cells.

Presented by Professor S. B. Partridge.

18. Carcinoma of the female breast. The wdiole mamma was extir-

pated, and also a mass of enlarged glands from the axilla ; — the
former is only preserved. The nipple is retracted, but not
ulcerated. The morbid growth consists of a nodule as large as
a potato, situated just beneath the skin ; the rest of the
mammary structure seems to have been converted into fibro-
adipose tissue. The scirrhus nodule is very dense and hard ; has
a yellowish-pink colour, and faintly fibroid appearance on section.

U nder the microscope, the structure is found to be characteristically carcinomatous
(scirrhus), and rapidly developing. The stroma is well marked ; the cells
are round or angular, with large nucleolated nuclei, lying heaped up in
great profusion in alveolar spaces, and also projecting, in the form of
elongated processes, into the surrounding fibro-adipose tissue. The cell
proliferation, — especially in nuclear form, — reaches and involves the cutis
vera.

Sections from the axillary glands showed distinct transformation of the lymphoid
into carcinomatous structure.

The patient, an East Indian female, a widow, aged 40, stated that the
disease was of about fifteen months’ duration ; “ no injury or
blow is remembered to have been received, nor has she had
recourse to any local treatment. No great pain was felt for
a year after the appearance of the tumour.”

Presented by Professor Iv. McLeod.

19. Enkephaloid cancer of the breast. The whole of the mamma

has been excised, but the morbid growth occupies only a
portion .of the gland, — a rounded, softish nodule, the size of a
small orange, immediately beneath the skin, and in close
proximity to the nipple. It consists of large, irregular,
epithelial cells, grouped together in great abundance in spaces
or alveoli formed by a connective tissue stroma. The latter is
scanty and fibrillated in character, not firm and dense as in
scirrhus. No history. Presented by Professor D. B. Smith.

20. Recurrent medullary carcinoma of the female breast. The prep-
aration exhibits the portions of the diseased gland removed in
the successive operations. It is recorded that the primary
growth was a small, “fibro-cystic tumour,” near the nipple. It was
removed ; — but the wound had scarcely healed when a truly
cancerous nodule appeared in the cicatrising line. Almost the
whole of the breast was then excised. After this, the patient,
a European lady, aged 40, “preserved a good state of general

484

EPITHELIOMA OF THE MAMMA.

[SEEIES XV.

health as well as complete immunity from the disease for about
three years.” A recurrence then took place near the cicatrix, not
in it. A tumour, the size of a walnut, was now excised, and
found to possess a truly cancerous (medullary) structure. In a
month’s time , a small pea-like growth again appeared, was of
the same structure, and was also removed. This made the
fourth operation. Lastly, in another three weeks, an indurated
and tuberculated condition of the cicatrices left by the third
and fourth operations having been observed, it was deemed
advisable to remove them, and also a considerable portion of the
surrounding integument. The ultimate result is not recorded.

An examination of the fragments of the recurrent growth preserved, reveals under
the microscope, all the characters of a fast-growing enkephaloid cancer.
The cell elements are very abundant, large, nucleated, and fatty ; — the
stroma scanty, but forming well-defined alveoli, &c.— J. F. P. McC.

Presented by Professor J. Fayrer.

21. “ Cancerous tumour removed from the right breast of a native

female, aged 45 years. Tumour of four years’ standing.”

This is a large fungating growth, occupying almost the whole of the
mamma, which is deeply ulcerated in the region of the nipple.
Its structure, microscopically, is that of enkephaloid carcinoma.
Presented by Professor J. Fayrer.

22. Colloid carcinoma of the mamma. “ Right breast of Mrs. M ,

aged 3G, mother of seven children. The breast became affected
with malignant disease about fifteen months ago. After her
admission a great portion of the tumour sloughed away, leaving
an ulcer, which is seen on the front of the breast, with sides
nearly approximated and deep perpendicular edges. The breast
was removed, together with a considerable quantity of the morbid
growth, which extended into the axilla as far as the sheath of
the axillary vessels.” (Colies.)

Examined microscopically, the structure of the morbid growth consists of
large, irregularly-rounded spaces or alveoli, filled with mucilagin-
ous flickering material only, or exhibiting the remains of degener-
ate epithelial cells — granular, fatty, and much broken-up. The
stroma composing the alveoli is formed by delicate, soft, connect-
ive tissue, also freely infiltrated with glistening mucoid or colloid
globules.

The structure of the extirpated axillary glands, and of the rest of the
morbid tissue above referred to, is very similar.

Presented by Professor J. Fayrer.

23. “ Cancerous tumour removed from the breast of a native woman.”

This is a large fungating tumour involving a considerable portion
of the mammary gland. It exhibits, under the microscope, all
the well-known characters of “ epithelioma.”

Presented by Dr. Bird, Howrah Hospital.

24. Epithelioma of the mamma (right) ; from a native woman, aged

35 years. The growth presents a broad, ulcerated, foul surface.
The whole of the gland is involved, as well as the superjacent
skin, and the surrounding cellulo-adipose tissue. The glands in
the axilla were greatly enlarged and indurated. The consistency

SERIES XV.]

SCIRRHUS OF MALE BREAST.

485

of the growth is firm ; the colour pale-yellowish, in parts mottled
and blood-stained.

On microscopical examination, the proper structure of the mamma is seen to have
disappeared to a considerable extent. Here and there in a section an
atrophied lobule may be discerned, the contained (secreting) cells in an
advanced stage of fatty degeneration. Epithelial cells of varying size and
contour — mostly fatty or very hyaline, many withered and distorted — infil-
trate the gland substance in every direction, replacing its proper structure.
The interlobular connective tissue of the gland is found rapidly proli-
ferating and softening, — exhibits very numerous nuclei and young epithelial
elements.

The tumour is said to have been of one year’s growth, had ulcerated
and rapidly increased during the last four months prior to
admission and operation.

Presented by Professor H. C. Cutcliffe.

25. “ A unilocular globular cyst, removed from the female mamma,

about four-and-a-half inches in diameter, with a portion of the
superimposed skin in situ. Its wall, the inner surface of which
is smooth, is about the sixteenth of an inch in thickness.”
(Ewart.) No history.

26. Left mamma of a native male, aged 24 years, by occupation a

cultivator, — amputated on account of a tumour, —a growth of
five years’ duration. There was no enlargement of the axillary
or other lymph-glands.

This is a flattened mass, rather larger than the palm of the hand, and
from half an inch to an inch in thickness. It includes the
whole gland, which has been cleanly removed down to the deep
fascia covering the pectoral muscles. The nipple is somewhat
large, prominent, and unretracted. The surrounding skin — a
portion of which has been removed with the mamma — is
unaffected, and not adherent to the gland. On incision, the
structure of the growth is very firm, brillkmt-white, fibrous-
looking, and throughout dotted about with rounded, firm nodules,
about the size of tapioca-grains. These consist, as seen under
the microscope, of the atrophied remains of the proper gland-
ular structure, while the main bulk of the growth is composed
of firm white fibrous tissue, sparingly nucleated and vascular.

It is therefore a fibroma, and quite a benign tumour.

Presented by Professor D. O’C. Raye.

27. Scirrhus cancer of the male breast, with enlarged and infiltrated

axillary glands. The patient was a Hindu, aged 45. The
growth is said to have been of two years’ duration.

The tumour is somewhat ovoid in shape, lobulated, and very hard and
firm in consistency, — cutting like cartilage. It presents a dense
fibrous appearance. The skin is adherent to the gland, especially
in the neighbourhood of the nipple ; the latter is small, fixed,
but not retracted. On one side of the growth the skin has
ulcerated over a space rather larger than a rupee (florin). Of
the lymph-glands — removed at the same time — one is the size

486

SARCOMA OF MALE BREAST.

[series XV.

oi a walnut, the others smaller ; all are firm, indurated, and fibroid
on section.

Oil microscopic examination of the mammary growth, the structure is found to he
typically scirrhus towards the peripheral portions. The stroma is very
well formed, thick, and nucleated; the epithelial proliferation within the
alveoli distinct ; the cells round, spindle-shaped, or angular (polymorphous),
nucleated, and granular from fatty changes. Towards the central parts,
the cell elements have almost completely disappeared, and only broad
bands of fibrous tissue exist, with, here and there, small interspaces filled by
dark, granular, fatty debris. Throughout the tumour the stroma is
unusually well developed, and would seem to indicate chronicity of growth.
The comparative scantiness of the epithelia may possibly be attributed to
the imperfect development of this gland in the male subject.

I he lymph-glands are undoubtedly infiltrated with cancerous germs. Sections from
them show, also, great increase of the fibrous parenchyma, with scattered
foci of epithelial cells, — mostly small and round, but quite different from
the ordinary and unchanged lymphoid cells observed (elsewhere) in the
same sections.

Presented by Professor D. O’C. Raye.

28. A malignant tumour (small-celled, spindle-celled sarcoma) of the
male breast. From a Hindu, aged 52.

The growth is as large as an orange, and has been freely extirpated.
It is slightly lobulated ; has no distinct capsule, — being inti-
mately and inseparably connected with the skin above, and the
cellulo-adipose tissue of the mammary region below. On bisec-
tion the tumour has a brownish, slightly fibrous or fibrillated
appearance, and consists of a series of closely cohering nodules
of varying size. The consistency is soft, except in one nodule more
deeply situated than the rest, and about the size of a walnut ; this
is very firm, and almost cartilaginous on section.

Microscopically examined, no trace of glandular structure is to be found. The
small nodule, last referred to, consists entirely of fibro-cellular (connective)
tissue, arranged in more or less circular or concentric strands. The greater
bulk and softer portions of the tumour consist of closely packed, small,
nucleated, spindle-shaped cells, with no formed intercellular substance, and
certainly no stroma.

Presented by Dr. E. L'awrie.

8EH1ES XVI.]

INDEX.

487

Series XVI.

DISEASES OF THE ORGANS OF SPECIAL
SENSE, AND OF THE SKIN.

INDEX TO THE SERIES.

A. -THE EYE (including the Eyelids, Lachrymal Apparatus,

and Orbit) —

1. — Arcus senilis, 1, 2.

2. — Glaucoma, 3.

3. — Morbid growths •* —

(a) Glioma, 4, 5, 6, 7, 8.

(b) Carcinoma, 9, 10, 11.

( c ) Fibroma, 12.

(d) Gumma (syphilitic), 13.

(e) Lymphoma, 14.

(f) Papilloma, 15.

(g) Sebaceous cyst, 16, 17.

B. — THE EAR (including the Tympanum, &c.) —

1. — Inflammation and suppuration, 18.

2. — Morbid growths : —

(а) Fibroma, 19, 20, 21.

(б) Enchoudro-sarcoma, 22.

C. — THE NOSE—

1.— Morbid growths

(a) Polypi—

i. Fibroid, 23, 24, 25.

ii. Mucoid, 26, 27, 28, 29.

iii. Adenomatous, 30, 31.

( b ) Gumma (syphilitic), 32.

D. -THE SKIN—

1. — Hypertrophy from pressure, 34, 35.

2. in “acute cedema,” 36.

3- — Pigmentation (bronzing) in morbus Addisonii, 37.

4. in purpura, 38.

5. —“ Tattooing,” 39, 40, 41, 42, 43.

* See also Series XVII.

488

DISEASES OF THE EYE.

[sEEIES XVI

6. — Inflammation and ulceration, 44, 45, 57, 76.

7. — Eodent ulcer, 46.

8. — “ Aihnum,” 47, 48.

9. — Syphilitic onychia, 49.

10. — Gangrene, 50, 51, 52, 53, 54, 55, # 56, 57, 58.

11. — Cicatrices, 59, t 60, f 61, J 62.§

12. — Morbid growths : — 1|

(a) Warts, 63, 64, 65, 66, 67.

( b ) Horns, 68, 69.

( c ) Keloid, 70.

{cl) Fibroma, 71.

(e) Molluscum fibrosum, 72, 73,

(/) Lipoma, 74, 75,

(g) Elephantiasis, 45, 76, 77.

(A) Carcinoma —

i. Scirrhus, 78.

ii. Enkephaloid, 79.

iii. Epithelioma, 68, 80, 81, 82, 83, 84, 85.

(i) Sebaceous cyst, 86, 87.

13. — Mycetoma (“ fungus-foot ” and “ -hand ”) —

(a) Dark variety, 88, 89, 90, 91, 92.

\h) Pale or ochroid variety, 93, 94, 95, 96.

1. The corme of a native woman, aged 60, showing the “arcus senilis,”

— partial in the left, complete in the right cornea.

2. “ Arcus * senilis ” of both corn®, from an East Indian female,

aged 80, who died of chronic diarrhoea.

3. Eyeball extirpated for acute glaucoma. The cup-shaped depression

of the optic disc, interruption of the retinal vessels at its margin,
and retraction of the optic nerve, are all well seen.

“ The disease was altogether of six months’ duration, but the acute
symptoms only came on about a fortnight before the operation.”

“ On opening the globe the whole of the choroidal epithelium was found
thinned and degenerated, and the choroidal structure exposed
in many places owing to shredding of the epithelial layer. The
vessels were also enlarged and very distinct.” The subject was
an East Indian gentleman, aged 72.

Presented by Professor II. Cayley.

4. A rounded tumour, the size of a small walnut, developing from the

sclerotic coat at the upper and anterior aspects of the globe of the
eye, and pressing upon the latter. The optic nerve is not involved,
and its structure is apparently healthy. The tumour-tissue is
somewhat soft, of a pale-yellowish colour, smooth and liomogene-

* From frost-bite,
t „ burn.

burn.

rabies (hydrophobia).

3 ft I diUloO ^LijUIUpilUUli

II See further, Series XVII.

SEBIES XVI.]

GLIOMA.

489

ous on section. It consists, under the microscope, of small round
nucleated cells, imbedded in a delicate connective tissue stroma,
which in parts is very deficient. The growth seems, therefore, to
be a glioma. No history.

5. Glioma of the eyeball. The growth is the size of a hen’s egg,

and consists of a delicately reticulated connective tissue, the
meshes of which enclose small, round, soft, nucleated cells. The
development is seen to proceed from the sclerotic and fibrous
sheath of the optic nerve. Tfie lens and other intra-globular
structures have become quite disorganised ; the cornea is hazy and
opaque.

6. “Malignant tumour of the left eyeball,” removed by operation

(extirpation of the globe), from a native child, aged about
18 months. It is said to have existed for one year. The
growth forms a large, reddish (in fresh state), fungating tumour,
which protruded upon the cheek between the eyelids. The
latter were much retracted, but not infiltrated by, or fixed to the
growth.

A longitudinal section through the extirpated eyeball shows great
and complete disorganisation of all the structures within the
globe. The optic nerve is small and atrophied. Prom its
sheath a soft, irregularly-rounded mass is seen developing. It
surrounds the posterior third of the shrunken globe, involving
the loose cellular tissue and remains of the ocular muscles here
situated. Growing inwards from the optic papilla and retina,
there is also a small, pearly- white, slightly granular-looking
nodule, the size of a hazelnut. It seems to have pushed the
choroid coat before it, and to have encroached upon the vitreous
chamber. The vitreous, lens, &c., are in a state of pulpy
softening, with here and there calcareous particles infiltrating
the same. The structure (microscopic) of the growth, both
extra- and intra-globular, is identical. It consists of small, round,
more or less uniform, nucleated cells, with a scanty and ill-defined,
fibrillated, intercellular material, i.e., a true glioma.

Presented by Professor H. Cayley.

7. “ Malignant tumour of the left eyeball.” This is a small, ill-defined

growth occupying the posterior third of the globe of the eye,
and intimately connected with the sheath of the optic nerve
and sclerotic coat. It evidently has originated from the sheath
of the optic nerve, which is thickened, and the nerve itself is
considerably compressed and flattened. Growing from this situ-
ation the tumour-tissue infiltrates all the soft parts at the back
of the globe, and thus forms an irregular-shaped mass the size
of a walnut; one portion of which— close to the perforation of
the sclerotic by the optic nerve — is abruptly rounded, and the size
of a horse-bean. It also has a uniform dark-red colour (in fresh
state), and is smooth, while the rest of the growth is whitish and
granular-looking.

On microscopical examination, the structure of the tumour-mass consists of small
round, nucleated cells, about the size of leucocytes, lying close together, i.e!
with little or no intervening or intercellular tissue. Here and there* the
fragments of a few nerve filaments or of fibrous tissue may be seen inter-
mingled with the cell proliferation. That portion which is of dark-red

GLIOMA.

490

[series XVI.

colour is found diffusely infiltrated with red blood-cells, and therefore owes
its tinge to this cause.

The tumour is the ordinary very common glioma of the eyeball. The
latter i3 entirely disorganised, and contains now only some
pulpy grumous-looking material, and small blood coagula.

“ History. The tumour commenced to grow about six or seven months ago,” i.e.,
prior to removal. “ The symptoms noticed at this period were conjunc-
tival irritation, soon followed by haziness of the cornea, and eventually total
loss of vision in the affected eye. About the latter end of last month ” (a
fortnight ago), “ the cornea suppurated and gave way, and a fungating mass
protruded through the rent from the interior of the eyeball. On admission,
the tumour was about the size of a large hen’s egg. It occupied the whole
socket, and protruded for about an inch and a half from it. It was firm
to the feel, exceedingly painful, and highly vascular — so much so, that it
bled at the slightest touch. The parents of the child (a native boy, aged
4 years) are healthy.”

Presented by Professor H. Cayley.

8. “ A tumour removed from the right eye of a Hindu male child, aged

one year and eight months. It is said to have been of fifteen
months’ duration. About a month before the operation it burst
through the cornea.”

The tumour, with the extirpated globe, forms a softly lobulated mass,
rather larger than a hen’s egg. On longitudinal section, the
eyeball is found much compressed and atrophied. The lens and
vitreous partially calcified. The growth surrounds the posterior
half of the sclerotic coat, from which, apparently, it has developed.
It is very soft and brain-like in consistency and colour, — in parts
is quite pulpy. The structure, under the microscope, is that of
glioma — small, round, nucleated cells, heaped together in great
abundance, and with very little intercellular tissue, — that which
exists is either granular and amorphous, or only slightly fibrillated.
Presented by Professor H. Cayley.

9. A flattened, bilobulated tumour, with a deep sulcus between its

component halves, in which the remains of a disorganised eyeball
can still be distinguished anteriorly, and posteriorly a quantity
of cellulo-adipose tissue, with the shreddy remnants of the ocular
muscles, and the optic nerve. The growth appears to involve
chiefly the eyelids ; has originated, probably, in one or both
of these appendages, and in its progress spread to the ocular
conjunctiva and cellular tissue around the globe, compressing
the latter and ultimately destroying it.

The proper structure of the tumour is soft and very friable, and
exhibits, under the microscope, all the characters of true
epithelioma. No history.

10. Enkcphaloid carcinoma of the left eyeball. From a native male,

aged 40. The tumour is said to be of only one month’s growth.
The whole of the eyeball, together with the upper and lower
eyelids, have been extirpated. The growth forms a soft,
yellowish or pinkish-white fungoid mass, protruding between
the eyelids, to the posterior angles of which it is intimately
adherent. The cornea has sloughed, and all the other structures

SERIES XVI.]

EPITHELIOMA.

41>1

of the globe are seen, on section, to have become quite dis-
organised and unrecognisable, — a. soft, yellowish, pulpy mass
with here and there extravasations of blood in its midst — taking
their place. The muscles of the eyeball are very soft and pale.
The optic nerve is a little softened and swollen.

Sections of the tumour, examined microscopically, exhibit a cancerous structure.
The cell-elements are large, epithelial and polymorphous ; have one, two,
or three large distinct nuclei, and are all considerably infiltrated with fat.
In parts, the cells are pigmented (brown). The stroma is scanty, but
characteristic. The blood-vessels large and numerous. The muscular
fasciculi (of the ocular muscles) are pale, have almost entirely lost their
transverse striro. The nerve fibrillse (of the optic nerve) are also granular
and much broken up, — undergoing fatty metamorphosis.

Presented by Professor W. J. Palmer.

11. A small epitheliomatous growth affecting the ocular conjunctiva,

lachrymal gland, and a portion of the upper eyelid of a native
male patient, aged GO. The eyeball and diseased structures
were removed together. The former shows some opacity of the
cornea, which is partially overlapped (at its outer and upper
margins) by prolongations from the morbid growth, spreading
inwards along the ocular conjunctiva. The sclerotic is not
affected. On bisecting the globe, the lens was found quite hard
and white ; the vitreous opaque ; the other structures normal.

Sections from the ulcerated upper eyelid and from the growth surrounding
the lachrymal gland exhibit, under the microscope, a very characteristic
epitheliomatous structure, with also considerable small-celled infiltration
of the muscular and other soft tissues involved by the growth in these
situations.

Presented by Professor H. Cayley.

12. “ rI umour situated in the left orbit, removed by operation from

a native (Hindu) male aged 40. It is of about four years’
duration.”

This is an oval-shaped growth, about an inch and a half long and three-
quarters of an inch broad, and has a distinct capsule of well-formed
fibrous tissue. On section, it is seen to consist of two lobules, —
one about twice the size of the other ; the two united by loose con-
nective tissue, and forming one tumour. On microscopic examin-
ation, the structure of the growth is found to be mostly fibroid. The
fibrous tissue very delicate, nucleated, and closely interwoven.
Here and there are seen glandular cells, — the remains no doubt
of the lachrymal gland, in which the little growth (a fibroma )
has originated. The smaller nodule is principally glandular, the
larger fibroid. In the former the capillary vessels are large —
presenting almost a cavernous arrangement.

Presented by Professor D. O’C. Raye.

13. A tumour of the orbit, with the extirpated (diseased) eyeball

The tumour is nodulated, and together with the extirpated
globe forms a mass the size of a small orange. The eyeball
is completely disorganised, flattened from before backwards —
reduced to a third of its normal size, and when laid open was
found filled with dark grumous-looking fluid only. The sclerotic

492

LYMPHOMA.

LSERIES XVI.

is distinct, and appears to be thickened. The optic nerve is un-
affected, except being perhaps a little compressed within its sheath .
From the latter the morbid growth clearly originates, surrounds it,
and is then continuous with the posterior two-thirds of the sclero-
tic. It has no capsule, but the shreddy remains of the ocular
muscles, &c., are seen attached to the circumference of the growth,
or partly imbedded in it. The tumour-substance is firm ; on section
has a yellowish-white, smooth, homogeneous appearance, — here
and there stained pink.

Its structure, under the microscope, consists of fibro-cellular tissue, the cell elements
predominating. They are, however, very small — more like nuclei, and the
great majority are dotted, i.e., granular from fatty metamorphosis. A few
small capillary vessels are found distributed in the midst of this nuclear
growth.

From the whole appearance of the tumour it seems to be of inflammatory origin — a
kind of slow development of granulation-like tissue from the optic sheath
and sclerotic coat, deriving firmness from a gradual transformation of
portions into imperfectly -formed fibrous tissue, while, at the same time,
many of the cell elements have atrophied and degenerated. The probabilities
are strongly in favour of its being gummatous.

“ The patient, a native male, aged 25, has been deaf from childhood,
otherwise healthy. First noticed protrusion of the eyeball six
weeks ago, and the tumour has gradually increased without pain.
Curiously enough, an exactly similar growth is forming in the
other orbit.” (Note by Dr. Cayley).

Presented by Professor H. Cayley.

14. A tumour of the orbit, about the size of a walnut, lobulated,

and enveloped in a more or less distinct connective tissue capsule.
It is surrounded by fatty and muscular tissue — the normal struc-
tures around the eyeball, matted together and fixed to the
tumour. On section, it presents an opaque-white or faintly
yellowish colour, and a glandular appearance. It is pretty firm in
consistency and moderately juicy.

Microscopically examined, the structure is found to be almost purely glandular

consisting of dense masses of small round lymphoid cells, contained in a
small-meshed reticulum of connective tissue. Towards the periphery, nerve
filaments and muscular fasciculi can be detected — incidentally involved in
the growth, but the proper tumour-tissue is clearly lymphoid, and sparingly
vascular.

The tumour is a simple lymphoma , and has originated, probably, in the
lachrymal gland. “ One lobe of the mass did project from the
upper and outer part of the orbit, and seemed to belong to the
lachrymal gland, but another was prominent below and to the inner
side of the eyeball, and the bulk of the tumour surrounded and
was intimately connected with the optic nerve. The eyeball was
not diseased, but very prominent.” {Note received subsequently
from Dr. Cayley). 'Presented by Professor H. Cayley.

15. Eyeball extirpated on account of a corneal growth, which, having

been removed (s< a few months back ) when quite small, recuiied,
and had increased rapidly. The growth is a soft warty -looking
mass covering the greater part of the cornea, and a considerable
portion of the adjacent sclerotic on one side. It is raised fiom

DISEASES OF THE EA1L

403

SERIES XVI.]

two to four lines above tliis surface ; presents a dull opaque-white
colour, and is entirely confined to the parts indicated, not
penetrating eyeball. The portion of cornea remaining uncovered
is about the size of a split-pea, is brownish, thickened, and
leathery. The sclerotic, choroid, and retina present nothing
abnormal, but the lens is quite opaque and hard.

Examined microscopically, the little growth is found to consist of papillary tufts
composed of rounded and flattened epithelial cells, lying very close to-
gether, and only here and there separated by a little very delicate connect-
ive tissue. The flattened cells are situated superficially, the rounder cells
more deeply, and all are more or less distinctly nucleated. Quite at the
base of the growth small cells or nuclei are found— probably young or
germinating epithelium, and the appearance is, therefore, as if the growth
had originated in the ocular conjunctiva on one side of the cornea, and had
gradually spread over and involved the superficial lamina of the latter.
There are no “ nests,” and no great diversity in the shape and size of the
epithelial cells composing the growth, which, therefore, is probably simply
papillomatous, not carcinomatous, in character.

The primary growth removed was situated at the outer canthus of the
(right) eye ; — was a fieshy-looking body about the size of a pea,
and had existed for eighteen months.

Presented by Professor H. Cayley.

16 A sebaceous cyst, the size of a pigeon’s egg, “ removed from under
the skin of the right eyebrow of a native lad aged 10.” It has a
firm, well-formed, connective tissue cyst-wall, and the contents arc
purely sebaceous, — consisting (under the microscope) of much fat,
and large numbers of flattened, withered, and variously distorted
epithelial cells ; also a few small hairs, — like those of the eyebrow.
These contents have a characteristic opaque, yellowish-white,
putty-like appearance and consistency.

Presented by Dr. E. Lawrie.

17. A similar cyst, the size of a walnut, removed from beneath the

skin of the left upper eyelid of a native male, aged 25, an out-
patient Presented by Dr. E. Lawrie.

18. “ Abscess of the left parotid gland, which communicated with the

meatus auditorius extern us.” (Ewart.) No history.

The suppurative process seems to have extended into the tympanum
and internal ear, and to have excited basal meningitis. The
dura mater investing the petrous portion of the temporal bone,
in the neighbourhood of the internal auditory canal, is abnor-
mally thickened and opaque, and coated by a thin layer of soft
granular-looking material, which, examined microscopically,
consists of recent exudation-matter or lymph.

19. Two small fibrous tumours — one the size of a pea, the other of a

hazelnut. They were both slightly pendulous, and growing
from the lobes of the ears of a young European sailor.

Presented by Dr. J. Ewart.

20. Two fibroid tumours removed from the lobules of the ears of a
native male (Hindu) aged 25. The quadrilateral-shaped tumour
belongs to the right ear, the triangular shaped one to the left,

“ Similar (but not quite so large) tumours first developed six
years ago, in the lobes of the ears, in the situations where they

494 FIBROMA OF EAR-LOBULES. [seeies xvi.

had been pierced for ornaments, after the holes thus produced
were allowed to close. They were removed after 18 months’
growth ; reappeared after six months, and were again removed;
reappeared for a second time in situ after an interval of two
months,” and the specimens now exhibited represent the growth
of two years, removed for the third time.

The remarkable recurrence of these growths in situ after removal by operation
is in accordance with the observations of Paget* and others, and affords a
good illustration of the fact that, occasionally, certain simple tumours as
these (consisting only of white fibrous tissue and a few elastic filaments —
on microscopic examination) may recur in situ without any element of
malignancy in either structure or history. — J. F. P. McC.

Presented by Dr. Dickson, Civil Surgeon, Dhurmsala.

21. A tumour (fibroma) “ removed from the back of the left ear. It

grew, apparently, from the cartilage, and recurred two years
after the first operation.”

This is a rounded growth, the size of a walnut, with a portion of the
skin attached. On section, it is yellowish-white, firm, and
decidedly fibrous-looking, — the arrangement of the fibrillae being
mostly concentric. Under the microscope, it is seen to consist of
well-developed white fibrous tissue, pretty freely supplied with
blood-vessels. Its connection with the skin is most inti-
mate and inseparable. It contains no cartilaginous elements.
Presented by Dr. E. Lawrie.

22. An irregularly oval-shaped tumour, the size of two fists, removed

from the left side of the face and neck of a native male patient,
aged 52. “ It is said to have originated in the lobule of the
ear.” The tumour is markedly lobulated at the surface, and
possesses a delicate yet distinct capsule of fibrous tissue, which
can be peeled off with a little care, and is only wanting where
the growth has ulcerated through the superjacent skin. On
section, the tumour tissue is opaque and slightly yellowish,
firm but elastic in consistency. The structure consists, under
the microscope, of chiefly fibroid cartilage - the intercellular
(fibrous) tissue and cell elements both well marked, — the latter,
apparently, in a state of rapid division and multiplication. Here
and there, however, are small masses or collections of round,
granular, soft, nucleated cells, — not cartilaginous ; these are
heaped closely together, and have no formed intercellular mate-
rial— in fact, possess all the characters of small, round-celled
sarcoma. The tumour is probably, therefore, a mixed one, i.e., an
enchondro-sarcoma.

Presented by Professor D. O’C. Raye.

23. A small, flattened, nasal polypus, having a short thick pedicle,

about a quarter of an inch in length. The growth has a yellowish-
white colour and firm consistency. It is composed of delicate,
closely-woven, white fibrous tissue, abundantly nucleated.

24. A fibroid polypus “ removed from the antrum Highmorii.” The

growth is about the size of a walnut ; irregularly lobulated ;

* Lectures on Surgical Pathology, 1803, p. 485.

SERIES XVI.]

DISEASES OF THE NOSE.

495

firm and fibrous-looking on section. Under the microscope, the
general structure consists of compact, firm, white fibrous (con-
nective) tissue, containing, also, elastic filaments. Here and there
are scattered, irregularly, small circumscribed spots of mucoid
softening, affecting evidently the remains of glandular follicles
included in the polypus.

Presented by Professor J. Fayrer.

25. “ Large fibrous tumour, springing apparently from the body of

the sphenoid, and occupying both nares, the spheno-maxillary
and right pterygoid and temporal fossm. A large lobe of the
tumour, marked now by two pins, lay within the cavity of
the skull, (separated from the brain by the dura mater), having
by its pressure led to absorption of the greater part of the bod y
and right wing of the sphenoid, and of part of the basilar and
left petrous bone. This part of the tumour was only removed
after death, as was also the adjacent lobe (transfixed by one pin)
which occupied the left naris, between the outer wall and mucous
membrane, shreds of which are still attached to it. The portion
of the growth occupying the right nasal fossa protruded
from the nostril ; that which occupied the temporal fossa has
some muscular fibres still adherent to it. The tumour when
removed weighed 7 ozs., and had been growing for about five
years. The patient, a Musulman lad, aged 14, died three hours
after the operation. The tumour consists entirely of dense white
fibrous tissue.” (Colics). See further, Indian Medical Gazette ,
July 18GG, pp. 181-82. Presented by Dr. W. B. Beatson, Super-
intendent, Mitford Hospital, Dacca.

26. A gelatinous polypus of the nose. It has a soft, gummy consist-

ency, and brownish-yellow colour. The pedicle is short and
slender. The structure is myxomatous, — consisting of a flickering
hyaline basis substance, infiltrated, with round, angular, and
stellate connective tissue corpuscles, which are nucleated, and
also exhibit mucoid changes. Presented by Professor J. Fayrer.

27. A gelatinous or mucous polypus nasi. A small, flattened, short-

pedicled growth, consisting (under the microscope) of very fine
fibro-elastic tissue, loose and lax towards the central parts,
infiltrated with mucoid and fatty material, and here and there,
exhibiting a few hypertrophied mucous glands or follicles.

Presented by Dr. R. H. Stevens.

28. A small polypus of the nose, having a slender short pedicle. Its

external surface has a pitted or honeycombed appearance from
a peculiar disposition of the most superficial or epithelial layer.
The deeper structure is firm, brownish, and fibrous-looking.
Sections from the growth show, under the microscope, a fibro-
myxomatous structure, consisting of much delicately reticulated
connective tissue, with round and oval cells imbedded in the
same, and both infiltrated sparingly with glistening opalescent
material. The blood vessels are small and not numerous.

29. A fibro-myxomatous polypus, the size of an orange, which

developed from the soft palate near the posterior nares, filled
the back part of the mouth, and extended backwards into the

49(3

NASAL POLYPI.

[series XVI.

fauces and pharynx, interfering thus very considerably with
both deglutition and respiration. The growth has a short but
distinct pedicle, and a broadly lobulated outline. It was easily
removed by the ecraseur. The surface of the polypus is invested
by thickened mucous membrane. On section it has a pearly-
white fibrous appearance and somewhat succulent consistency.

Microscopically examined, consists of well -formed, closely-meshed, and abundantly
nucleated fibrous or connective tissue, with numerous blood-vessels and
highly-developed tubular gland-structures, — all of which are best marked
in the superficial portions, i.e., just beneath the mucous membrane. More
deeply, the structure becomes looser and laxer, and is largely infiltrated with
mucoid material, but otherwise presents no abnormal growth.

From a Mahomedan lad, aged 16. It is said to have been of only four
months’ duration. Presented by Professor K. McLeod.

30. A firm, oval-shaped, but flattened polypus nasi, with a greatly
elongated pedicle. It is of dull white colour ; the surface slightly
pitted. On microscopic examination, the structure is found
homologous with that of the mucous lining of the nares, and
consists of an hypertrophied condition of the epithelial layer, the
sub-epithelial connective tissue, and the muciparous gland-
structures of the same : these last, in particular, are largely
developed ; their acini enlarged, full of proliferating gland-
epithelium ; their ducts elongated and tortuous. The growth
may therefore be regarded an adenomatous variety of nasal
polypus.

31. A large glandular polypus, removed from the posterior nares of a

European sailor, aged about 24 years. It projected into the
pharynx to so great an extent as to interfere materially with
respiration and deglutition. “ It had been growing for some
months, but no inconvenience was experienced until it began to
hang over the pharynx.”

This is a pyriform tumour, two and a half inches in length, an inch and
a half broad, and at the base about an inch in thickness.

On microscopical examination, the structure of the growth is seen to consist of a
series of acini and tubules (the normal gland-structures of the post-faucial
region) hypertrophied, and separated by moderately wide meshes of a
delicate connective tissue, among the fibrilla) of which small, round,
lymphoid cells are observed. The polypus is, therefore, an adenomatous
growth.

Presented by Dr. J. Ewart.

32. A portion of the frontal bone, with (1) a circumscribed, almost

completely ossified node, just above the right supraorbital arch ;
and, (2) a large tumour, which has perforated the cranium through
the right orbital plate, and filled the greater part of the right
nostril. The latter growth is smooth, and invested by a delicate,
but distinct fibrous capsule, where it projects into the nares. It
is pulpy and broken up (flocculent) within the cranium. The
consistency is throughout soft.

On microscopical examination, the structure consists of fibro-nucleated tissue. This
assumes hero and there, a distinctly nodular character j in other parts has no

SBK1ES XVI.]

DISEASES OF THE SKIN.

497

specific arrangement. In the former case, the disposition is very character- \
istically gummatous. Small depots are found composed of opaque, granular,
amorphous material, surrounded by imperfectly formed connective tissue
and blood-vessels, and these, in turn, by more perfect fibro-elastic tissue.
The blood-vessels show a very remarkable thickening of their walls, with
diminution of the lumen or calibre. There is no other cellular or morbid
infiltration. The growth seems to be truly syphilitic or gummatous.

From a native male (Mahomedan), aged 50, who died in hospital of
acute dysentery. ( See further, “Medical Post-mortem Records,”
vol. Ill, 1880," pp. 713-14.)

33. Small-celled, spindle-celled sarcoma, forming a semi-polypoid
growth which was “ removed from the left side of the septum
nasi of a woman aged 30.” The tumour is slightly lobulated,
and invested by a thin capsule of delicate connective tissue.

It is very soft in consistency, homogeneous and yellow-
ish-white in appearance. It consists of small, nucleated,
spindle-shaped cells, and a few also round or oval. There is no
intercellular substance, and no formed stroma.

Presented by Professor J. Fayrer.

84. A portion of skin from the shoulder of a native palki-bearer,
showing very considerable hypertrophy, the result of intermittent
pressure caused by the manner in which this conveyance is borne
on the shoulders.

3F. “ The great and little toes of the right foot, preserved to show

the formation of hard corns with adventitious bursae over
prominent points of bone. The hypertrophied skin has been
raised from the metacarpo-phalangeal joint of the great toe,
so as to show the bursa lying between the corn and the joint.
The corns on the little toe have been divided down the centre,
and their halves held apart, so as to expose the cavities of the
bursae.” (Colles.) Presented by Professor J. A. P. Colies.

36. Portions of skin from two cases of “ acute oedema” (pseudo beri-
beri), prevailing in an epidemic form in the southern and south-
eastern portions of the city and suburbs (March 1880).

The two smaller fragments are from one case, the two larger from
the other. Both show considerable solidity and brownish-red
discolouration.

On microscopical examination, no change is found in the epidermis or papillary layer
of the cutis vera ; no abnormal or defective pigmentation. The meshes
of the cutis below the papillary layer appear larger, frayed out, and
partially broken down. There is no marked alteration in the hair follicles,
sweat, or sebaceous glands. The adipose tissue is abundant and of reddish-
brown colour. This is duo in parts to blood staining, in others to actual
extravasation — blood corpuscles being recognised in abundance in the fibrous
septa between adjacent fat lobules, and even between the fat cells. It seems
probable, therefore, that the peculiar induration of the skin and subcuta-
neous tissues, so characteristic of this disease, is due to extravasated blood
in the latter situation, — the fibrin solidifying in the deeper cuticular
strata, while the more peripheral are widened out, and, as it were, rarefied
hy the serous effusion ; both thus producing “ solid oedema ” of the affected
parts. Portions of the liver in each case, examined at the same time,
exhibited very marked peri-lobular fatty infiltration of the hepatic cells
and interlobular tissue. The epithelial lining of the kidney-tubules was
swollen and granular (“ cloudy swelling ”), but there was • nothing else

498

PIGMENTATION.

[sEEIES XVI.

remarkable in the structure of the renal organs. In one case the heart
s owed very advanced fatty metamorphosis of the muscular fasciculi.

37. Three portions of skin, — the two larger taken from the inner and

tiont part of each thigh, the smaller piece from the right mammary
and axillary region. . They all exhibit intense pigmentation of a
coppery tinge (bronzing). Similar cutaneous discolouration, in
patches,, was distributed throughout the body, and was especially
marked in the face and flexures of the joints.— From a native
male patient, a Hindu, aged 40, who showed symptoms of morbus
Adclisonii, and ultimately died from ascites associated with
cirrhosis of the liver.

The supra-renal bodies in this case were found on post mortem examination much
atrophied, and showed considerable density and hardness from fibroid thick-
ening of their capsules and proper (gland) parenchyma.

38. Portions of skin taken from the dorsal aspects of the fore-arms,

exhibiting large purplish blotches, and also small punctiform
blood extravasations into the cutis vera * From a case of scor-
butus or scurvy,— an English seaman, aged 62. The skin of
the feet and legs showed similar changes. The patient was
admitted into hospital in a very low and prostrated condition,
suitering from dysentery, and the immediate cause of death was
haemorrhagic meningitis (cerebral). (Sec further, “ Post-mortem
.Records,” vol. I, 1874, pp. 471-72.)

3^ , Poitions of tattooed skin from the arm of a European sailor
who died of cholera. The designs represent (a) the crucifixion,
(b) a ship in full sail, (c) an anchor with a scroll above it
bearing the word “ Hope.”

similar specimen. The pigment is blue, probably gunpowder.

41. Portions of “tattooed” skin from the fore-arm and thigh of

an aboriginal New Zealander (Maori), a seaman, aged 25, who
died in hospital. The artificial dark blue pigmentation (prob-
ably from gunpowder) contrasts markedly with the bronzed
condition of the natural skin.

42. 43. Two specimens of “tattooed” skin from the arms of British

seamen. The colouring is rich and brilliant, both blue and
red. Probably gunpowder and cinnabar were employed.

44. Acute inflammation and ulceration of a portion of the skin of a

thickened and elephantoid scrotum. The ulcer is rather larger
than a rupee (florin), and has a very irregular, raw, somewhat
fungating appearance. After removal of the scrotum by the
usual operation, the patient (a Chinese, aged 25) recovered
completely.

45. “ Sloughing ulcer in an elephantoid leg. Amputation, recovery.

Patient was 60 years old. This is a good example of inflam-
mation occurring during one of the repeated paroxysms of
elephantoid fever, passing rapidly into extensive sloughing and
destruction of the soft parts.” (Ewart.)

The appearance of parts has been much altered by long maceration in spirit.

SERIES XVI.]

“ AIHNUM.”

499

46. Rodent ulcer, affecting the skin and subcutaneous tissues of the
left mamma. The subject was a native female, aged about 40.
“ The disease is said to be of five months’ standing.” The
ulcer is about the size of the palm of the hand ; has abrupt,
thickened, slightly tuberculated margins ; the centre is deeply
excavated. In sections made through its whole thickness, the
subcutaneous tissues are found condensed and firm. Very little
of the glandular structure of the mamma is seen, the ulcer
having involved the skin, &c., on only one side of the gland ; it
has, however, reached the subjacent pectoral muscles.

Examined microscopically, sections show (1) little or no alteration of the epidermal
layer of the skin ; (2) an expansion of the cutis vera, — the cell elements
of which are in a state of rapid proliferation, and contemporaneous dis-
integration. (3) In the subcutaneous structure, the white fibro-elastic
tissue is hypertrophied, forming dense filamentous bands interlacing with
each other in all directions, and, distributed along and between the
fibrous bands, are large numbers of small, irregular-outlined, nucleated
cells and free nuclei. (4) Here and there sections of gland-ducts — com-
pressed and filled with atrophic and degenerate epithelium — are found.
(5) In the deeper layers, largely developed blood-vessels are met with. The
general morbid histology precludes epithelioma, and points more closely to
lupus or rodent ulceration.

Presented by Professor W. J. Palmer.

47. “ Aihnum” or specific ulceration of the little toe. From a native

adult (male). From the section which has been made it will be
seen that the terminal phalanx of the toe remains entire,
and the ball of the toe is formed by dense white fibrous tissue,
holding in its meshes a large quantity of granular fat. The
articulation between the terminal and middle phalanges is nor-
mal,— the encrusting cartilage quite healthy. Of the middle
phalanx only the distal half remains, the rest has been converted
into fibro-adipose tissue, and is constricted posteriorly to form
a kind of pedicle, by which it was attached to the proximal
phalanx of the toe, and from which, at this spot, it was
becoming gradually detached by a slow ulcerative process. The
skin is considerably thickened over the whole of this little
“ tumour.” Presented by Dr. A. Crombie.

48. Preparation illustrative of the condition known as “aihnum.”
This, the little toe, “ was almost spontaneously amputated across
the first phalanx. The groove extended to three-fourths the
depth of the toe.” From a native male patient. “The pain
disabled him from work. The first phalangeal bone is completely
converted into thick fibrous tissue surmounted by a carti-
laginous shell, representing its articular surface.” A similar fatty
and fibroid degeneration affects the bony tissue of the middle
and terminal phalanges, but the articular cartilage between

these phalanges still persists, and the joint seems to be healthy.

Presented by Dr. Gopaul Chunder Roy, Beerbhoom.

49. Hypertrophied and superficially ulcerated great toe, amputated
at the m etatarso-phalan geal articulation. The toe is large and
bulbous, three times its natural size. The surface is raw-looking,
— covered by numerous small papules and ulcers; the nail

500 GANGRENE. [series xvi.

is atrophoid, and has almost disappeared. On longitudinal
section the phalangeal articulation is found healthy, but
surrounding the terminal phalanx is a fibrous-looking growth,
which, under the microscope, consists of fibro-elastic tissue
plentifully infiltrated with small nuclei and germs, yet showing
no differentiation into formed structure, i.e., a kind of nuclear
infiltration of the overgrown natural tissues of the part.

The patient, a native male, aged 25, stated that “ four months ago spontaneous
ulceration of the integument occurred over the root of the nail ; it extended
to the tip of the toe and beneath the nail, which has since been almost
destroyed.

He had chancre about five years ago, for which he was salivated.”

The disease evidently consists of syphilitic infiltration and ulceration
of the nail and soft parts forming the ball of the toe— a severe
variety, apparently, of syphilitic onychia.

Presented by Dr. Herbert Baillie.

50. “ Gangrene of the left foot. The skin of the dorsum and sole is
as black as pitch. About the line of demarcation the integument
is destroyed by ulceration exposing the mortified part below.”
(Ewart). This line extends in front across the ankle joint, and
posteriorly is directed obliquely upwards about three inches above
the heel. No history.

51. “ Gangrene of the right foot of a native child, aged five years,

from embolism, during an attack of remittent fever of sixteen
days’ standing. Bulla? are seen on the dorsum and sole of the
foot.” (Ewart.) Presented by Assistant Surgeon C. Bysack.

52. A preparation showing a series of toes which have separated spon-

taneously after gangrene.

53. “ Dry gangrene of the right foot and lower half of the leg after

fever, and due to embolism of the tibial arteries. The limb was
amputated after the line of demarcation had formed. The subject
was a native male (Hindu).” (Colies.)

54. “ Spontaneous gangrene of the left foot, embracing all the toes.

Amputation by Chopart’s operation. From a native male, aged
25.” (Ewart.) The great toe alone remains, and the line of
demarcation between it and the metatarsus is well seen. The
other toes appear to have dropped off, or were removed during
the operation. Presented by Professor J. Fayrer.

55. “ The two hands of a Portugese sailor illustrating dry gangrene

caused about three months ago by frost bite. Amputation at the
wrist-joints was performed.” (Ewart.)

Presented by Professor S. B. Partridge.

56. “ Both feet of a native female patient, (Hindu), aged 25, separated

through the ankle-joints from dry gangrene, coming on after
fever. Fever began three months and the gangrene one month
ago.” (Colles.)

57. Extensive gangrenous disorganization of the soft parts surround-

ing the left wrist and hand of an old and debilitated Hindu (aged
50) who, seven months previously, had a “ moxa ” applied to the
inner side of the palmar aspect of the wrist “ for the cure of an
enlarged spleen.” The ulcer thus produced, never healed, partly

SERIES XVI.]

DRY GANGRENE.

601

owing to its depth, but chiefly, probably, from the constitutional
debility of the patient, and on account of bis having undergone,
subsequent to its formation, a mercurial course “ for gonorrhoea.”
On the anterior aspect of the wrist and hand the flexor tendons
are exposed and partially destroyed, —the ulcerative process has
extended in depth as well as in breadth. On the posterior aspect
of these parts are three other large ulcers. As there was no
evidence of any reparative change even after two months’ careful
treatment in hospital, the hand was amputated two inches above
the wrist-joint.

Presented by Professor S. B. Partridge.

58. Spontaneous dry gangrene of the left foot, the result of calcareous
degeneration of the arteries. The patient, a native male, aged
25, of intemperate habits, was, three years previously, admitted
into hospital with a similar condition (dry gangrene) of the right
foot, for which the leg was amputated. He has remained well
since. The present disease commenced (according to him) only
fifteen days ago, — a small sloughing ulcer appearing spontaneously
on the plantar aspect of the great toe, and spreading gradually so
as to involve the whole foot.

The posterior tibial artery has been dissected out and laid open. It was
found pervious as far as behind the inner malleolus, but greatly
shrunken, and so also were the accompanying veins. The arterial
coats are rigid and partially calcareous.

The femoral artery, on this side, from below the prefunda, was rigid, irregularly
calcified (i.e., at intervals), and contracted to the size of an ordinary
radial. In the popliteal space it was completely occluded. The right
knee-joint was dry and mummified. {See prep. No. 50, Series III.)

60.

^(“Surgical Post-mortem Records,” vol. I, 1874, pp. 81-82 )

“ A club-foot, the result of extreme contraction of the cicatrix of
an extensive and deep burn over the instep and inferior part of
the anterior aspect of the leg, sustained many years prior to
death. The dorsum of the foot is drawn up by the contracted
cicatrix, and firmly opposed to the front part of the lower leer
so that the patient must have only impressed the heel upon the

ground during locomotion. The new tissue is dense and unyield-
ing. (Ewart.) J

A preparation showing the results of a severe burn inflicted upon
the right upper extremity during infancy, with the somewhat
\ -shaped and web-like cicatrix between the fore-arm and arm
drawing them closely and almost immovably together
The patient, a native boy, aged 14, died in hospital from pulmonary
phthisis. He was burnt, accidentally, four days after birth.

6 -st-join and fingers have coalesced to form a rounded shapeless
mass, the size of an orange. Only a rudimentary thumb can be
distinguished.

A portion of skin from one of the fore-arms of a native male patient
showing a circular depressed cicatrix, nearly as large as a rupee
(florin), produced by the application of the “ moxa a verv
common practice among natives for the relief (P) of various
diseases, e.y., hypertrophy of the spleen, elephantiasis, &c.

61.

602 WARTY GROWTHS. [series xvi.

62. A portion of skin from the palm of the left hand, showing two

linear cicatrices, each about a quarter of an inch in length, the
results of bites (healed) from a rabid bitch. The cellulo-adipose
tissue beneath each is somewhat condensed and firm, and a few
filaments from the median nerve can be traced into the same.

The subject was a native male (Hindu), aged 25, who became hydro-
phobic five weeks after the bite, and died in hospital.

On dissecting and examining the nervous filaments alluded to, nothing specially

morbid could be detected in their structure. Considerable irritation of the l
cutis vera and subcutaneous tissues is, however, evidenced under the
microscope, viz., a proliferation of the small round cells of the former, with
an extension downwards of a small-celled growth into the subcutaneous
tissues from the bases of the papillae. (See further, “ Medical Post-mortem i

Records,” vol. I, 1876, pp- 995-96).

63. A large warty growth, with a flattened base about the size of the

palm of the hand, and a highly papillated surface. The
projecting papillae are almost horny in character, and, near their
peripheral extremities, darkly pigmented.

The structure, microscopically, shows enormous development of the

epithelial layer of the skin (and chiefly of the epidermis), but j
no other marked change. Presented by Professor S. 13. Partridge.

64. Tumours from the left clavicle and right fore-arm of a girl

of 10, removed by operation. They present “cauliflower
growths on their cutaneous surfaces. Similar tumours existed
on the right side of the abdominal wall, and the conjunctiva at
the edge of the left upper eyelid ; and others were situated
below the left nipple, and over the right scapula. The tumour
on the fore-arm was the oldest, and had existed for seven years.”

These appear to be warty growths. Under the microscope, the deeper
layers of the cutis are seen to be hypertrophied,— bands of
white fibrous tissue with elastic filaments and nuclei forming a
dense interlacement, while the superficial layers with the epidermis
are developed into warty papillomatous outgrowths.

Presented by Dr. E. C. liensley, Civil Surgeon, Midnapore.

65. Large warty growths, of six months’ duration, which involved

the skin of the whole perineum, and formed a circular fringe
round the anus. The growths are lobulated as well as being
divided into minute warty excrescences.

Under the microscope, the epithelial proliferation is most marked, especially that of
the papillary layer of the cutis. Each little warty outgrowth is composed
of a series of very highly hypertrophied papillae ; towards the central
portions of which no epithelium exists, but is replaced by a nucleated
connective tissue, and delicate looped capillaries.

From a native female, aged 28. “ She denied having suffered from

syphilis.” Presented by Professor Gayer.

66. A peculiar diffuse, warty, or papillated condition of the skin

of the palm of the hand, and of the phalangeal flexures of the
fingers, associated with leucodermic patches of irregular outline
and dead-white colour. Each papule is darker than the skin
on which it is situated, is raised and hard ; and, where several
arc grouped together, a more markedly warty appearance is

SEMES XVI.]

WARTY GROWTHS.

503

produced. The right hand was similarly affected.

Obtained post-mortem, from a native male, aged 45.

67. A warty growth, rather larger than the palm of the hand,
removed by operation. It involved the skin on the anterior
and upper part of the right leg. (From a Hindu female, aged
about 50). “ A small warty excrescence had existed at this

part for several (more than thirty) years. Three months ago
she scratched it and made it bleed, after which the growth
ulcerated, spread, and became irritable and painful. The
popliteal and inguinal glands on the right side were enlarged
and indurated.”

The growth is ulcerated and partially cicatrised towards the centre ;
raised, nodulated, and tuberous towards the periphery. It
appears to be entirely dermal in structure, — consisting of a
series of closely-packed warty developments of an opaque-
white or yellowish colour. The subcutaneous adipose tissue is
thick, but apparently uninfiltrated, and the superficial fascia
of the leg (which has been removed with the tumour) is quite
healthy- looking.

This is confirmed on microscopical examination, — sections taken from the growth

exhibiting a proliferous epithelial structure to a certain depth only,

no prolongations into the deeper subcutaneous tissues, — and a basis-
substance or matrix of delicate, nucleated connective tissue with
numerous capillary blood vessels. The tumour is not epitheliomatous, hut
warty in character.

Presented by Professor K. McLeod.

68. A very interesting specimen, showing the recurrence(F) of an
epithelial cancer in the cicatrix remaining from the removal of
a similar(P) growth. The patient was a young native female.
Fight months prior to her admission into hospital, a growth,
said to be “ as large as a pomegranate,” was removed from
the “ posterior aspect of the right gluteal region, by an Assistant
Surgeon.” When admitted, the cicatrix was occupied, at one
extremity, by a circular, slightly raised ulcer, with hard, eroded
edges; at the other, by a prominent horn-like growth. The entire
cicatrix with a portion of the surrounding healthy skin was
now removed,— as seen in the preparation. Under the micros-
cope, the ulcerated mass is found to possess all the characters of
true epithelioma (cancer), while the horn-like growth is built
up of a series of brownish, slender, perpendicular columns, closely
massed together, and consisting of dry, shrivelled, epithelial
cells, angular, distorted, and generally irregular in shape, almost
perfectly transparent, and for the most part without nuclei,
i.c., a simple non-cancerous growth.

The interest attaches to the peculiarity of the development of a truly infiltrating
epithelial (cancerous) growth at one encl of the cicatrix, and a non”
cancerous, non-infiltrating, but still epithelial (horny) development at the '
other. — J. F. P. McC.

69.

Presented by Professor H. C. Cutcliffe.

“Keloid-looking growths, of about four months’ duration
removed from the leg of a native out-patient, aged about 40.” ’

504

FIBROID GROWTHS.

[series xvi.

70.

71.

These are flattened warty or horny-looking growths from the shin on
the outer aspects 'of both legs. The integument here had a
contracted, cicatricial-like appearance, — said to be the result of

a severe burn. < .

Examined minutely, the surface of each little growth is soft and
creamy, breaking down under pressure of the fingeis into a
sabulous paste. Under the microscope, the chief change, appears
to have taken place in the papillary layer of the cutis. Ihe
epidermis is moderately hypertrophied. The papillae of the skin
are greatly developed, — secondary and tertiary papillaiy layers
being here observed, the epithelial structure of which is well
marked, and so abundant as to form “ nests ” (as in true epitheli-
oma), but does not descend into or penetrate the .subcuticular
tissues. The latter are normal, with the exception that the
hair-shafts and bulbs are compressed and atrophied, and the
sebaceous glands are dilated into cyst-like cavities with fatty

and degenerate epithelial contents. „

The structure of these little growths is therefore quite unlike keloid,
and has closer analogies to horny or warty cutaneous develop-
ments. Presented ly Dr. E. Lawrie. ..... , . e

“ A keloid growth removed from the middle sternal region of a
young European sailor. It had developed here in connection

with an old cicatrix.” (Ewart.) .• T.

A subcutaneous fibroma, removed from the forehead of a native
male, aged 34, -an out-patient. The growth is the size of a small
orange ; has a well marked capsule of connective tissue, strong y
adherent to the skin on the anterior aspect. It is firm and elas-
tic on section, smooth and homogeneous, and of a milky-wh
colour. Consists (microscopically) of delicate connective
fibrous tissue, the fibrillar of which interlace very closelj and
compactly. Many elastic tissue wavy filaments are also includ-
ed in the structure of the growth. The b ood vessels. are moder-
ately large and abundant. Presented by Di. E. Lawiio.

A portion of a verv largo tumour, which involved the skin and
subcutaneous tissues of the buttocks and lower part of , the spine,

&o. The subject was a native male aged 2*. He stated t,l

“ there was a congenital nodular thickening of the skin on the
right side of the sacrum, which has slowly and gradually mcicas-

ed, and is still progressing.” . „ ,, f , i

The portion removed and preserved is a mass the size of the fetal head
1 or a little larger. The skin is intimately adherent to the morbid
growth, and is stained of a very black colour,— as if >» .

Of silver This pigmentation, however, is natural, not artiticial,
and'eontrasted strongly with the light-brown colour of the skin

The section a series of rounded firm nodu-

g lar tumours are observed, varying m size from a walnutto .8 jPJt.
These are all situated beneath the skin, in the loose fibio-cellu
tissue of the part. Examined more . closely they present"
fibroid appearance ; the fibrous tissue is veiy o ica e u >
and has a distinctly concentric arrangement, ihe cut suiiac

72.

SERIES XVI.]

MOLLUSCUM FIBROSUM.

505

has a pearly-white lustre. Some of the nodules show central
softening and caseation ; each has a well-formed capsule of fibrous
tissue, from which it can be easily shelled out.

Examined microscopically, the fibroid character of these growths is confirmed. Each
little tumour is composed of white fibrous tissue, with here and there a few
elastic filaments. The fasciculi of this fibrous tissue are closely interwoven,
and have a well-marked concentric or laminated arrangement. Thickly
distributed amidst this tissue, and enclosed in the small spaces left by
the intersections of its fibrillm, are large numbers of small round cells
or nuclei — about the size of ordinary lymphoid or gland cells. These are,
in parts, aggregated to form small deufits, and show incipient fatty
softening and caseation. The fibroid tumours described do not lie very
closely together, but are separated by a considerable quantity of loose
connective tissue, which is soft and flickering in parts from mucoid
infiltration. Blood vessels are large and numerous in this tissue, and the
vascular supply of the independent nodules — distributed chiefly along their
capsules — is also abundant.

Tbo whole mass consists of (a portion of) a pendulous outgrowth of
the skin of the parts specified, and implies an hypertrophied
condition of the subcutaneous structures, including, probably,
the cutaneous glands and hair follicles. It may be regarded
therefore as a somewhat unusual form of what is known as
molluscum fibrosum, — the growth being composed of a mass
of conglomerate (though individually distinct) fibroid tumours,
instead of separate and distinct pediculated outgrowths.
Presented by Professor Gayer.

73. Molluscum fibrosum. A pendulous fibroid growth, removed from

the left gluteal region of a native female, aged 22. “ Her body

is covered with small similar growths, — said to be congenital.”

The preparation exhibits one of these cutaneous outgrowths, the size
of an orange, and slightly lobulated. On section, it is seen to be
directly continuous with the cutis vera, and to be densely
fibroid in appearance. Plas a pale waxy colour, and cuts with
difficulty.

Under the microscope, the structure consists of nucleated white fibrous tissue,
the filaments of which are arranged, for the most part, concentrically'
and thus form a series of rounded nodules closely hound together by
similar tissue. At the centre of each such laminated nodule the cross-
sections of two or more small capillary vessels are observed. In parts,
the tumour-substance is soft and gelatinous from mucoid changes. There
is no capsule.

Presented by Professor D. O’C. Ilaye.l

74. A fatty tumour about the size of a melon, and more or less

rounded in outline, removed from the interscapular reo-ion of
a native male, aged 3G. The tumour weighs 3G ounces, and
was the growth of twelve years. At the centre there is a large
cavity, the result of suppuration and breaking down of the
substance of the tumour in consequence of inflammatory
changes, which followed upon the application of the “ moxa ”
by a native “ hakim.” The skin at this part is very intimately
adherent to the surface of the tumour, and presents an ulcerated

506

ELEPHANTIASIS.

[series XVI.

75.

76.

and partially cicatrised condition. The tumour tissue is
purely fatty (lipoma.) Presented by Professor Gayer.

A small polypoid fatty tumour (lipoma) found attached to the
inner side of the left thigh of a native female, aged 23, who
died from cholera. It was removed post mortem. The pedicle
is three-fourths of an inch in length and half an inch thick.
The superjacent skin is closely and inseparably connected with
the growth.

Elephantiasis arabum (bucnemia tropica ) of the right foot and
leg? — a growth of four years’ duration.

first it was accompanied by fever, recurring at regular intervals during
every full moon. During the last two years it lias increased rapidly.
From the, consequent over-distension of some parts, the swelling began
to give way at several points, leading to the formation of ulcers of
varying shapes and sizes. These healed up spontaneously, and they were
succeeded by fresh crops, which underwent a similar cycle of changes.
Hence the ulcers were of variable duration, some having existed longer
than others. About two inches below the knee the swelling commenced,

extending to and including the whole of the foot and toes.’

girth
un-

At its greatest circumference the leg measures 32 inches. The

of the foot is about 15 inches. The tissues are hard and _
yielding. There are numerous irregular elevations and depressions,
cicatrices of liealed-up ulcers, and fresh ulcerations. The exist-
ing ulcers are five in number. The largest is situated on the
external aspect of the leg, about two inches above the ankle. It
is surrounded by an irregular thickened margin, and gave exit
to a thin yellowish matter. Three ulcers are placed above this
large one, and have nearly cicatrized. There is a large ulcer
on &tlie dorsum pedis , surrounded by indurated, thick, and
irregular margins. It reaches from the inner side of the loot to
about an inch from the outer margin. It is superficial in some
parts, at others it penetrates even to the bones by fistulous

communication.” (Allan Webb). ,

Elephantoid hypertrophy of the right foot and ankle. Ihe leg
was similarly affected to within four inches of the knee-joint,
at which spot amputation was performed. Ihe skin ot the
parts preserved presents a very characteristic tuberous, nodulated,
and greatly thickened appearance. The subcutaneous cellular
tissue is enormously developed, and, in the recent state, was
charged with much pale, limpid serum, which exuded also
during life from small ulcerations on the dorsum of the foot.
The muscles are pale and flabby ; the bones of the foot soft, an
abnormally fatty. Presented by Professor J. I ayrer.

. .1 OH AVn.lK TP.. Wll(

78.

lie

abnormally iaeey. j. r vy . . , n

A scirrhus tumour, about the size of an orange, which mvo lved

the skin and mucous membrane over the left side of the lace
extended inwards to the palate, and backwards to the pterygoid
process of the sphenoid bone. It was removed from a native
male patient, aged 60, who had enjoyed good health up to the
commencement of the growth, i.e., about three and a half mo
prior to the operation.

attributed the development of the tumour to a bruise or contusion from
the horn of a cow. The skin and subjacent tissues became swollen and

SERIES XVI.]

EPITHELIOMA.

507

painful, the swelling subsided in a few days, leaving a small indurated mass,
which increased very slowly and with hut little pain until some six weeks
ago, when it was punctured by a Koberaj. The puncture healed in three
or four days, but the tumour has since this increased rapidly in size, and
been accompanied by much pain of a throbbing character.”

The growth, on section, has a white, glistening, fibrous appearance ;
exudes on pressure a slimy, tbickish, milky fluid, which, under
the microscope, exhibits various shaped, multi-nucleated cells,
abundant free nuclei, and much granular and molecular fat. Fine
sections reveal a very characteristic scirrhus structure, — both
stroma and cells being well marked, the former unusually thick
and abundant, considering the very rapid growth of the tumour,
as above related. Presented by Professor H. C. Cutcliffe.

79. A portion of the cutaneous cicatrix of a healed amputation

(wound) at the hip-joint, for enkephaloid carcinoma of the femur,
showing nodular infiltration and recurrence of the growth. From
a native lad, aged 15. There were similar secondary develop-
ments or deposits in the lumbar glands, lungs, diaphragm, &c.
( See further, “ Surgical Post-mortem Records,” vol. I, 1877, pp.
397-98.)

80. A large epithelial cancer involving the skin and subcutaneous
tissues of the sacral and gluteal regions of a native male (Hindu),
aged 35. It constitutes a large, flattened, ovoid, and ulcerated
mass, eight inches in length and six inches wide ; has a hard,
indurated base, and very uneven, fungoid, and irregular margins
and surface. The former are from half to three-fourths of an
inch in thickness, everted, and eroded, with numerous nodules
and tuberculated excrescences.

History . — Three years ago, the patient states, an abscess appeared in the left
gluteal region, which opened spontaneously and discharged foetid pus
through four or five orifices in the superjacent skin. The swelling caused
by the abscess subsided, but purulent material continued to drain through
the sinuses, and the indurated condition of the surrounding parts per-
sisted, and after a time began to extend, being accompanied by much pain.
He then underwent a mecurial course, and was salivated. This was suc-
ceeded by much general debility, and no local improvement.

On the contrary, -a month after, — and just twelve months prior to admission into
hospital, — he noticed the presence of nodular excrescences about the
mouths of the sinuses. The intervening skin ulcerated, and took on
similar fungoid changes, and in this manner the entire diseased surface
has acquired its present appearance and infiltrating character. No
hereditary history. Has never had syphilis.

Sections made through tlie margins of the fungating and ulcerating

o o o o o

mass reveal a true epitheliomatous structure. The cuticular
papillm are much enlarged, and extend deeply into the subjacent
cellulo-adipose tissue ; — the epithelial proliferation within and
beneath them is most luxuriant and abundant, and contributed
to by a hyperplastic condition of the sebaceous glands, &c.
“ Nests ” or “ globes ” are very abundant.

Presented by Professor J. A. P. Colies.

81. A small, flattened, warty-looking growth removed 'from the left

leg of a native male patient, aged about 2G years. It is said to

508

EPITHELIOMA.

[series XVI.

have been of two years’ duration, and to have appeared in an
old cicatrix (.left after the healing of a superficial abscess).
It is fungating, papillomatous, ulcerated ; about three and a
half inches in length and one and a quarter inch in breadth. The
epidermis is raised into tuberous and villous excrescences, and
the surface of the growth generally has a warty appearance.

A fine section, under the microscope, exhibits well-marked epithelial growth,—
the cell elements involving the cutis as well as the epidermis, and
reaching into the sub-dermal tissues in the form of a small-celled or
nuclear^proliferation. Numerous epithelial “nests” and finger-glove-like
prolongations into the subcutaneous connective tissue are observed. The
growth appears to be, therefore, truly epitheliomatous (cancerous), not
(warty).

82. A flattened epitheliomatous growth removed form the front of the

thorax of a native male, aged about 40. “ It commenced, he

stated, as a small hard swelling, about four years ago, and
remained stationary up to within the last six months, when it
ulcerated, and has since spread rapidly.

The growth is of rounded outline, but flattened and saucer-like. Has
hard, scolloped edges. The surface is covered with luxuriant
papillary developments, and has a yellowish -white colour. This
part of" the growth is soft ; the base is firmer, and rests upon the
pectoral muscles, portions of which have been removed with it.

Sections, under the microscope, exhibit a highly developing epithelial structure,—
affecting chiefly the true skin or dermis,— which is much hypertrophied.
It extends, however, into the subcutaneous cellulo-adipose tissue, which is
abundantly’ infiltrated with small round cells and nuclei. Numerous
« nests,” entire or fragmentary, are scattered throughout the sections. The
growth is a true cutaneous epithelioma.

Presented by Professor K. McLeod.

83. Epithelioma of the right fore-arm, affecting the skin and sub-

cutaneous tissues on the anterior and outer aspects of the limb.

From a native male patient, aged 40. The growth forms a large fun-
gating mass, four inches in length by three inches in breadth.
Under the microscope it presents all the characters of epithelial
carcinoma. The proliferation of large, polymorphous, epithelial
cells in elongated prolongations from the cutis downwards, the
presence of numerous “ nests,” &c., are all well marked. The
morbid cellular infiltration reaches the flexor muscles, but
apparently invades only their superficial layers. The ulna
and radius are both unaffected.

Presented by Professor S. B. Partridge.

84. Epithelioma of the skin and soft parts on the inner aspect of the
left foot and ankle, — treated during life by caustics. The patient,
a native male, aged 35, was admitted into hospital in a very
reduced and emaciated condition from pulmonary phthisis, and
died of this disease about a week after. The morbid growth
takes the form of a large spreading and eroding ulcer, which
involves the skin, fascise, and the superficial muscles and tendons.
It extends from the internal malleolus to the sole of the foot.
The skin of the heel is not affected, nor the soft parts covering

SERIES XVI.]

SEBACEOUS CYSTS.

609

the metatarsus and toes. The margins of the ulcer are thick
and irregular. Its surface is highly vascular, nodulated or
tuberculated, of a dusky-purplish colour (in the fresh state) ; here
and there sloughy and softened, but, for the most part, firm and
exuberant-looking. It apparently does not implicate the ligament-
ous structures of the foot. The posterior tibial artery (dissected
out) is found pervious, as also its external and internal plantar
branches. The latter lie in close relationship to the base of the
ulcer in the sole of the foot.

Sections from the tuberculated surface of the ulcer exhibit a luxuriant growth of
large, polymorphous, nucleated, epithelial cells, which are grouped together
in irregular -shaped, solid, tubular masses. At the margins of the ulcer, the
structures composing the skin are found in a state of active proliferation —
especially the papillary layer; and the cutis vera generally is seen
infiltrated with small round cells and nuclei. (“ Surgical Post-mortem
Records,” vol. I, 1878, pp. 451-52.)

85. Epithelioma of the skin removed from the thigh of a native male,

aged 60. The growth is said to have been of two years’ stand-
ing. This is a large, unhealthy-looking ulcer, the size of a five-
shilling piece. Its edges are raised and eroded, are formed by
thickened tuberculated nodules of a rosy-red or greyish colour.
The base is similarly, in parts, raised and rugged ; iu others,
deeply excavated.

The structure, as seen under the miscroscope, is that of true epithelial
cancer, — at the margins of the growth especially, the epithelial
proliferation is most marked, and can be traced into the sub-
jacent (subcutaneous) tissues in the form of small cells and nuclei
which are very abundant at the bases of the epithelial prolonga-
tions. Characteristic “ nests, ” &c., are found in the superficial
portions of the growth.

Presented by Professor K. McLeod.

86. A sebaceous cyst of oval shape, and about the size of a walnut.

It contains thick, brownish, putty-like material, and many long
yellowish hairs. Presented by Dr. E. Lawrie.

87. A cyst removed from the posterior aspect of the upper part of

the right thigh of a native woman, aged about 30. The
cyst-wall is alone preserved. Its contents were in a state of
suppuration. The former consists of well-developed connective
tissue, lined on the interior by delicate, semi-transparent, pelli-
cular patches, having a close resemblance to normal sJcin, i.e.t
composed of superimposed layers of flattened epithelium, with
traces of gland-structure and rudimentary hair bulbs and
shafts. The growth is therefore a sebaceous or dermoid cyst.

L Presented by Dr. E. Lawrie.

r Mycetoma of the left foot. From a native woman of A j mere, in
Rajpootana. The disease was of ten years’ standing. After
amputation the patient made a good recovery. The°foot has
been bisected by an ordinary scalpel passing through the tissues
from the interdigital space between the second and third toe in a
line towards the middle of the tibia, and through the centre of
the ankle-joint.

610

MYCETOMA.

[SEBIES XYI.

“ The scalpel passed readily through all the tissues except the tibia

and the portion of the astragalus articulating with it. The foot

is enlarged in all directions ; the toes are turned upwards ; and
there are several openings on the surface, which may generally
be found to communicate with a cavity in the tissue below.
Some of the orifices are plugged, more or less completely, by
irregular-shaped aggregations of black substance, which can be
picked out. On examining the section, the outlines of the
tarsal bones can be made out ; but the bones occupy an irregular
space perforated by numerous excavations in all directions.

* # # “ The cavities are in some cases isolated, but in

others they communicate by means of one or more channels with
adjoining cavities, the cavities and channels being everywhere lined
by a more or less dense, smooth membrane of tough fibrous tissue.
The cavities are of very unequal size. They "vary from being just
large enough to contain a pellet of small shot to being sufficiently
capacious to hold a bullet with ease. They almost invariably
contain irregular lumps of dark granular substance, which moie
or less completely fills the cavities and channels continuous wit
them. Frequently, however, the dark material occupies but a
portion of the cavity, even though the cavity be completely
isolated. The fatty padding of the sole of the foot appeals
to be normal, but' in two or three places small groups oi
the lobules have been replaced by cavities containing the dar
material.”

Microscopically examined, the muscular tissue is for the most part healthy. 1 e
fibrous tissue lining the cavities and channels is “ in no way to be distin-
guished from similar tissue lining cavities in other abnormal conditions.
The bone, though soft and much cancellated and porous, shows nothing else
remarkable. The dark material “ after subjection to more or less prolonged
action of liquor potassse ” exhibited numerous filaments and circ"larJl)od'^
(Lewis and Cunningham,— vide Spec. I., p. 43, “Report on the Fungus

Disease of India,” 1875.)

Presented by Dr. Thos. Murray, Civil Surgeon, Ajmere.

89. A well-marked example of mycetoma or “Madura toot. ine
disease commenced eighteen months before the date of amputation
as a slight swelling, with little or no pain. To this succeeded a
small papule, which bursting, discharged small black giains o a
substance resembling gunpowder.”

In the preparation three longitudinal sections have been made from the
dorsum downwards through nearly the whole thickness, of the
foot, exhibiting, very distinctly, the characteristic softening and
hollowing out of the osseous structures, with long sinuous
channels leading from them to the surface, and the presence ot
an abundant dark, granular, sooty deposit in both excavations and
sinuses, and also, as an infiltration, in small masses, into the soft
parts beneath the skin. On the plantar aspect where the skin
has been preserved entire, the equally characteristic, appearance
presented by the raised and perforated papules which open into
the sinuses leading into the deeper parts or interior of the foot
are well seen, as also the generally hypertrophied or tokened
condition of the whole integument. The foot (left; has been

SERIES XVI.]

MYCETOMA.

511

removed by Chopart’s amputation. “ The central portion of the
second metatarsal bone, is, in great part, occupied by a dark-
brown, spherical mass about an inch in diameter, shaped some-
thing like a potato, and presenting a slightly radiating, finely
striated appearance on section. It is moulded to the cavity in
which it is lodged, and its projecting nodules fit accurately into
adjoining cavities in the surrounding tissues,” * * * * *
“ The cavity communicates with both dorsal and plantar surfaces
of the foot by means of irregular channels containing small
black masses. There is another large cavity situated somewhat
behind the one just described and above the plantar fascia. It
also contains dark tuberculated masses, and opens into several
small cavities, which communicate with the surface on the sole
of the foot.” Several other cavities with similar contents are
exposed by the other sections made through this foot.

“ The black material contained the usual filaments, but none of these could be found
in either the muscular, osseous, or fibrous tissues of the surrounding parts,
although carefully searched for by every known method.” (Lewis and
Cunningham, loc.cit., p. 52, Spec. No. V.)

Presented by Dr. H. F. Williams, Ferozepore.

90. Mycetoma or fungus-disease of the right hand, which has been
amputated a short distance above the wrist-joint. “ The hand
is considerably thickened and the wrist swollen. The palmar
surface is puffed up, and numerous openings both here, on the
dorsal surface, and between the fingers, communicate with a
large cavity within. A scalpel carried longitudinally through
the middle of the hand readily divides the bones that still
remain, as well as the end of the radius for a short distance. All
the carpal, together with a great part of the metacarpal bones
are destroyed, the basal half being the portion in the latter most
affected. The phalanges are somewhat softened, but not eroded,
and contain no black matter.” ******* “The cavities
in the bones are not lined, and the bone presents the appearance
of ordinary caries. The cancellous tissue of the end of the
radius, and of such portions of the carpal bones as remain is very
porous and widely opened out. Where, however, the cavities
are located among the soft tissues, they are lined by a membrane.
The tendons are not affected. The large cavity referred to as
communicating with the surface by means of various channels,
occupies the space normal to the carpal bones, and is filled with
fragments of these bones mixed with black granular material,
which also extended into the channels alongside of the tendons.”

“ The black material, after prolonged immersion in liquor potass®, was found to
contain filaments, but they were by no means so plentiful as ordinarily
observed. Not the slightest indication of any such filaments could be
demonstrated in any of the parts recognizable as tissues whether diseased
or healthy,” (Lewis and Cunningham, loc. cit.)

91. Mycetoma of the right hand. “ The whole hand is considerably

swollen ; and the fingers bent towards the palm. On the dorsum
of the hand are several sinuses, through which the characteristic

512 MYCETOMA. [series xvi.

black granules were discharged.” (Colles.) The longitudinal
section which has been made through the hand shows much
thickening and matting together of the superficial soft parts
(tendons, fasciae, and cellulo-adipose tissue, &c.), with the deposit
of masses of very dark granular material amidst them. This
deposit extends upwards on the back of the wrist, beneath the
skin and superficial fascia, in a linear manner. The deeper struc-
tures— carpal and metacarpal bones — are softened, carious-looking,
and hollowed out in various directions, so as to present a some-
what honeycombed appearance, the small compartments of which
are more or less filled with the same black pigment matter.

This hand was also examined by Drs. Lewis and Cunningham ( loc . cit , p. 50, Spec.
No. Ill, Dark Variety), who report — “the distal end of the os magnum is
found to be completely disintegrated, and between it and the upper end
of the second metacarpal bone is lodged a mass of dark-brown substance,
the brown tint predominating towards the centre, where it might almost
be described as presenting a dark-red tint. Several other aggregations
of dark material are found lying between this mass and the flexor tendons. •’
* * * * * “ In the dark masses filaments could be distinguished after

prolonged immersion in potash ; but, in the yellowish, roe-like particles,
picked out of the same cavities and similarly treated, no such filaments
could be demonstrated when the particles were carefully selected.”

Presented by Mr. P. A. Minas, Civil Surgeon, Hissar.

82. A mycetoma of about eleven years’ growth. The patient, a
Hindu, aged 40, was a native of Burdwan. “ There was no
history of syphilis or of injury to the part. Amputation at the
upper third of the leg was successfully performed.”

The specimen (right foot) exhibits all the well known characters of the
dark variet}1- of this disease, described so fully in connection with
the preceding preparations. The morbid structures were care-
fully examined immediately after the operation, and while the
parts were quite fresh, but no traces of sporules or filaments
could be discovered — no fungus forms of any description — in
either the diseased tissues or in the dark pigment-material
infiltrating them. Presented by Professor Gayer.

93. A mycetoma or “ fungus-foot ” (right), removed by amputation
at the lower third of the leg, from a Mahomedan labourer, aged 25,
“a resident of Kistnanagore (a village about 40 miles north-east
of Calcutta).”

There are numerous prominent perforated papilla} on the plantar and
dorsal aspects of the foot, into which a probe can with ease be
passed to a depth of from four to five inches. The whole foot is
much clubbed and swollen, and the superficial soft parts greatly
thickened ; — these conditions extending to about two inches
above the ankle-joint. The lower ends of the tibia and fibula
are also involved in the disease. On longitudinal section, the
bones of the tarsus and metatarsus are found extremely soft and
spongy, —cutting most readily with a scalpel.

History. — The disease commenced about two years ago by the spontaneous appear-
ance of certain papules or small vesicles over different parts ot the sole ol the

SEKIES XVI.]

MYCETOMA.

513

foot. These lasted a week or ten days and then “hurst,” discharging a little
pus. While one crop of such formations was healing a second appeared, —
sometimes on the sole, at others on the dorsum of the foot, and followed
the same course. At this time, he states, there was no appreciable swelling
of the foot, and no pain experienced except in walking. About twelve
months ago, however, ho twisted the foot “ while reaping corn,” and the
accident was followed by enlargement and swelling of the same, which
rapidly increased for about two months, and then as suddenly subsided.
During this time he experienced very severe lancinating pain in the part :
numerous fresh vesicles appeared over the thickened skin, discharged thin
purulent fluid, and their orifices assumed a somewhat prominent and
fungoid appearance. He was -weakly-looking and anaemic when admitted
into hospital, but there was no visceral disease, and, after the amputation, he
recovered completely. There was no evidence of constitutional syphilis or
struma.

This is a well-marked example of the pale or ochroid variety of myce-
toma, and shows characteristic fatty degeneration with caries of
the soft parts and osseous structures, but there is an entire
absence of the dark, gunpowder-like pigment matter met with in
the other variety of this disease.

Careful microscopical examinations of all the tissues and materials present
were made by Drs. Lewis and Cunningham, “ but in no case did
they afford the faintest evidence of the presence of any fungal
or fungoid bodies, or of anything save degenerations of the normal
elements of the tissues.” ( Vide Spec, No. I, “ Pale Variety,” p. 15
loc. cit .) Presented by Professor H. C. Cutcliffe.

94. Mycetoma of the left foot, — a section showing the peculiar and
characteristic fibro-adipose degeneration of the tarsal and meta-
tarsal. bones. The. skin on the dorsum and inner side of the
foot is covered with numerous rounded and slightly elevated
fistulous openings, which lead into long sinuous channels commu-
nicating with the diseased osseous structures. No black adven-
titious material is found. The specimen belongs to the male
variety of so-called “fungus-foot.”

The patient was a young Mahomedan adult, a resident of Burdwan.

rou^d particles. These roe-like aggregations « qnito ^”the ZSSS

514

MYCETOMA.

[series XVI.

oily.” The muscular and tendinous structures “ little, if at all, affected.”
As regards the caseous matter and roe-like particles within the cavities,
the former consists of “ yellowish amorphous material mingled with oil-
globules ; readily acted upon by liquor potassae, and when treated with thi3
reagent frequently gave rise to an abundance of tubes, filaments, and glob-
ules of myeline. The particles forming the roe-like masses are composed of
a large central mass or nucleus of similar caseous matter densely clothed with
radiating crystals,” ** * * “ Prolonged and careful microscopic examination
failed to reveal the presence of any fungoid elements notwithstanding
the use of most various reagents,”

Presented by Professor J. Fayrer. •

95. “A foot affected with “ Podelkoma,” “ mycetoma, or tuberculosis
pedis,” (called “ Jceernal ” by the people of Rohtak, and
“ Keereenagrcth ” in Sirsa).” The appearance, of the foot is
very characteristic. It is greatly swollen, especially from above
downwards ; the tarsal arch, has completely dis appeal ed ; and
both plantar and dorsal surfaces are covered with fistulous

« xbe toes are shortened, turned upwards, and more or less drawn
backwards into the foot, so that the latter presents a peculiar
thick, stumpy aspect.” A section has been made through t e
foot longitudinally. All the osseous structures are greatly
softened, porous in texture, and full of yellow oily material,
with here and there distinct aggregations of roe-hke particles.
The soft parts show various degrees of fatty degeneration, Ine
cavities in them are occupied by “ masses of circular, yellowis 1-
white grains or particles, like small seed or ova, aggregated into
masses of various sizes, and evidently forming the roe-like bodies
so constantly described as characteristic of ? the discharges and
tissues in this variety of the Madura disease.

« An the varieties of morbid material present in this case were carefully ransacked
with the aid of the most various agents and appliances, with the view
of ascertaining the presence of any vegetable organisms or other foreign

foaurs StoenS of them, bat entirely in v.in .» The dreease cons.s.e
merely of “a degeneration of the normal constituents of tl e tissues,
^associated with, and uncomplicated by, the presence of any extraneous

elements.” (Lewis and Cunningham, loc. cit. p- 20, Spec. No. Ill, 1

Variety.”)

Presented by Dr. W. P. Dickson, Rohtak. TJ /m,nrf

96 Mycetoma of the right foot. Presented bxj Dr. Harvey, (B -

pore) who says — “ it is the foot' of a man aged 50. I was first
dined to think it a case of Fungus Disease. I can, however,
detect no sporules, and there is no history of any black dischai ,
although, there is a good deal of dark tissue about the sole If
it is a sample of elephantiasis, the case is a peculiar one, as the
leg was qdte healthy1 above the ankle, and there was no enlarge-
ment of the glands in the groin, ^he disease began
a"o as a discolouration near the ball of the gie . • , i

formed after a time and discharged a white fluid-thick and
glairy — not like pus. It has gradually increased, and the foot

weighs 91b 10 ozs. The openings are very numerous, and a
probe goes deep down many of them, as it does in cases

mycetoma.”

SERIES XVI.]

MYCETOMA.

515

The specimen is undoubtedly a mycetoma. The shape of the foot is
characteristic, — the arched prominence of the dorsum being well
marked, the toes retracted, &c. There are also numerous sinuses
leading down deeply into the morbid tissues, and when they
are slit up are found to be occupied by soft, yellowish or yellow-
ish-pink, granular material. Moreover, a longitudinal section of
the foot having been made, this same granular matter is seen
filling numerous small cavities both in the cutis (which is a
good deal thickened), and in the bones of the tarsus. The
latter are exceedingly soft and brittle, — the metatarsal bones in
a state of dry necrosis. These conditions are distinctive of
m}rcetoma, and are not met with in elephantiasis.

The microscopic examination of the coloured granular material shows no spores or
mycelium, although macerated for several hours in liquor potass©; it
appears to consist of amorphous hit granules and molecules only, and
probably represents a peculiar granular change or metamorphosis of the fat
into which the bones and other tissues have slowly become converted, and
is identical with the roe-like particles characteristic of the pale variety
of mycetoma. In the pinkish tinged material the remains of altered
blood corpuscles are visible. — J. F. P. McC.

PATHOLOGICAL MUSEUM.

MEDICAL COLLEGE, CALCUTTA.

A. 11 T IX.

TUMOURS AND MORBID GROWTHS.

Series XVII.

SERIES XVII ]

INDEX.

619

Series XVII.

TUMOURS AND MORBID GROWTHS.

INDEX TO THE SERIES.

A.— NATURE OF THE TUMOUR OR GROWTH.

I. — Sarcomata —

1. Round-celled, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13.

(a) Alveolar, 14, 15, 16, 17, 18, 19.

(b) Glioma, 20, 21, 22, 23, 24.

2. Spindle-celled, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37,

38, 39, 40.

(a) Pigmented (melanotic), 21, 41, 42.

3. Myeloid, 43, 44, 45, 46, 47.

4. Mixed, 48, 49, 50, 51, 52, 53.

II. — Fibromata —

1. Simple, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68,

69, 70, 71, 72, 73. 74, 75, 76.

2. Mixed, 77, 78, 79, 80.

III. — Myxomata —

1. Simple, 81, 82, 83.

2. Mixed, 84, 85.

* [3. “ Elephantoid ” growths, 86, 87, 88.]

IV. — Lipomata —

1. Simple, 89, 90, 91, 92, 93, 94, 95, 96.

2. Mixed, 97, 98, 99, 100.

V.— Enchondbomata —

1. Hyaline, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110.

2. Fibroid, 111, 112, 1L3, 114, 115.

3. Stellate, 116.

4. Enchondrosis, 117.

5. Osteoid tumour or periostoma, 118.

6. Enckoudro-sareoma, 119, 120, 121.

VI.— Osteomata —

Simnle f Compact, 122, 123. 124, 125, 126, 127, 12 la.

1 ”• {(b) Spongy, 128, 129, 130, 131.

Mixed (osteo-sarcoma), 132, 133, 134, 135, 136.

* See also Series XIII,
of the Skin.”

“Scrotum;” Series, XIV, “ Labium;" and Series XV, “Diseases

520

INDEX.

[series XVII.

VII. — Lymphomata—

1. Simple, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146.

2. Lympkadenoma (Hodgkin’s disease), 147 (P), 148, 149, 150, 151,

152, 153, 154, 155, 156.

VIII. — Papillomata —

1. Cutaneous (warts, horns, &c.), 157, 158, 159, 160, 161*, 162, 163,

164, 165*.

2. Mucous, 166.

3. Serous (psammoma), 167, 168, 169, 170, 171, 172, 173.

IX. — Adenomata —

1. Acinous, 174, 175, 176, 177, 178, 179, 180.

2. Tubular, 181, 182.

X. — Carcinomata —

4.
[5.

Scirrhus, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, l93f,
194f.

Enkeplialoid, 195, 196, 197, 198, 199, 200, 201, 202, 203.

Colloid, 204, 205, 206.

S(a) Squamous, 207, 208, 209, 210, 211, 212, 213.
214, 215, 216, 217, 218, 219, 220, 221, 222,
223, 224, 225, 226.

v (&) Columnar or cylindriform, 227, 228, 229.
Melanotic, 230, 231, 232, 233.]

XI. — Myomata, 234, 235+ 236+ 237, 238§, 239||, 240, 241||, 242§, 243]:,

244^[, 245 §, 246]!, 247J, 248, 249§, 250];.

XII. — Neuromata, 251, 252.

XIII. — Angiomata —

Simple/253, 254, 255.

2. Cavernous, 256, 257.

3. “ Aneurism by anastomosis,” 258, 259.

XIV. — Cystomata (cysts, homceoplastic and neoplastic) —

1. Sebaceous, 260, 261, 262, 263, 264, 265, 266, 267, 268,

269, 270.

2. Mucous, 271, 272, 273.

3. Serous, 274, 275, 276, 277, 278.

4. Sanguineous, 279, 280.

5. Colloid, 281, 282, 283.

6. Multilocular or compound, 265, 285, 286, 287, 288, 289, 290.

7. Proliferous (including dentigerous, dermoid, &c.), 291, 292,

293, 294, 295.

8. Congenital, 296, 297.

XV. — Specimens from the lower animals, 298, 299, 300.

X Polypoid.

* Melanotic. t Recurrent.

§ Calcified || Interstitial.

1 Multiple.

SERIES XVII.]

INDEX.

521

B. — SITUATION OF THE TUMOUR OR GROWTH.

1. Cranium or scalp, 8, 214, 223, 268.

2. Basis cranii, 4, 82, 167, 168, 169.

3. Orbit, 23, 24, 179, 252, 257.

4. Eyeball, 20, 21, 22, 166, 197, 198, 230.

5. Nose, 83, 117, 202.

6. Antrum, 118, 202.

7. Mouth, 61, 215, 271.

8. Tongue, 224, 225.

(•Upper, 46, 47, 59, 67, 68, 70, 71, 1 12, 127«.

9. Jaw ... < Lower, 14, 44, 56, 57, 68, 62, 63, 69, 74, 75, 80, 111,

( 123, 124, 127.

10. Lip, 107, 212, 216, 220.

11. Ear, 65, 66, 256, 287.

12. Parotid region, 17, 78, 84, 113, 178.

13. Submaxillary region, 38, 105, 115, 138, 152.

14. Neck, 40, 97, 140, 144, 146, 156, 265, 266, 274.

15. Thyroid, 273, 281.

16. Mediastinum, 148, 149.

17. Mamma, 96, 174, 175, 176, 177, 183, 184, 185, 186, 187, 188,

189, 190, 191, 192, 193, 194, 195, 196, 206.

18. Axilla, 139, 145, 151.

19. Shoulder, 90, 100, 132, 270, 272, 280.

20. Arm, 7, 12, 13, 26, 31, 77, 253.

21. Forearm, 1, 2, 5, 6, 9, 11, 29, 34, 35, 43, 45, 119, 120, 251.

22. Hand, 3, L5, 41, 60, 200, 258.

23. Finger, 102, 103, 116, 208, 226.

24. Abdominal wall and viscera, 30, 73, 89, 150, 153, 154, 155, 182,

204, 228, 229, 250, 259, 277, 282, 283, 294.

25. Iliac region, 109, 254.

26. Back, 10, 50, 51, 52, 53, 98, 219.

27. Buttock, 76, 94, 160, 267.

28. Groin, 18, 91, 95, 143.

29. Thigh, 16, 32, 37, 72, 92, 93, 121, 122, 126, 128, 129, 133, 137,

203, 255, 297.

30. Popliteal space, 49, 133, 142, 163.

31. Leg, 19, 25, 28, 39, 107, 108, 110, 125, 130, 131, 134, 135, 157,

213, 218.

32. Foot, 27, 33, 36, 42, 79, 80, 101, 104, 161, 201, 217, 231, 232,

278.

33. Perimeum, 158.

34. Anus, 165, 227.

35. Penis, 164, 211, 221, 222.

36. Prepuce, 87, 88, 159,209, 210, 211, 221.

37. Testicle, 48, 199, 276, 279.

38. Vulva ( labia. &c.), 86, 99, 162.

39. Uterus, 234, 235, 236, 237, 23S, 239, 240, 241, 242, 243, 244
245, 246, 247, 248, 249.

Ovary, 180, 205, 284, 285, 286, 288, 289, 290, 291, 292, 293,

40.

522

SARCOMATA.

[SEBIES XVII.

1. A round-celled sarcoma involving the lower end of the left

radius. The growth has originated in the cancellous tissue of
the lower extremity, and, extending centrifugally, has caused
thinning and expansion of the bone around it, so as to form
a tumour the size of a large orange, of lobulated outline
and very soft consistency. An investment by the original
periosteum (greatly developed) can be traced over the greater
part of the tumour, but is wanting where the latter has
ulcerated through to the surface. At the periphery, for a
depth of from to the growth is semi-solid in consistency,
beyond which, as the centre is approached, it is seen to have
completely broken down into a pulpy, soft, brownish or
blackish mass of disorganising tissue, which, under the
microscope, shows only the debris of cells, much fat, and
pigment matter (blood). Sections from the firmer portions of
the tumour reveal all the characters of a fast-growing sarcoma,
viz., a highly cellular tissue — the elements mostly round, some
spindle-shaped, a few myeloid,— nucleated, granular, lying
close together, and with no formed intercellular substance.
No history.

2. “ Two fungating enkephaloid tumours projecting considerably

above the integument, and connected with the soft parts
covering the olecranon process of the ulna. They are lobulated.
The patient was a Mahomedan, forty years of age. The
disease had only lasted six months. During its extirpation,
resection of the elbow-joint was performed, because it was
thought that the head of the ulna participated in the morbid
growth.” (Ewart.)

The growth under the microscope exhibits a purely sarcomatous
(round-celled) structure, and is not enkephaloid. The posterior
surface of the olecranon process is deeply excavated, and from
the periosteum or cancellous tissue of the bone here the tumour
has probably developed. (J. F. P. McC.)

3- An excavated, crater-like growth, developing from the metacarpal
bone of the thumb. A section shows that this bone has
almost entirely disappeared, — has been absorbed into the
growth. The first and second phalanges are not involved. The
structure is everywhere soft and friable, smooth or but slightly
fibrillated. Under the microscope it exhibits a highly cellular
condition, — the cells are round or spindle-shaped (the majority
round), a little larger than leucocytes, and distinctly nucleated.
There is no true stroma ; the intercellular substance is through-
out scanty, in parts shows faint fibrillation.

The soft parts on the dorsum of the thumb are extensively ulcerated.
No history.

4. Round-celled sarcoma. A portion of the skull of a Hindu, aged 57,
showing the presence of a malignant growth at its base, which,
developing apparently in the sphenoidal sinuses, has extended
into the nasal and orbital fossae, and, through the cribriform
plate of the ethmoid, into the cranial cavity. The right eyeball
is pushed outwards, and a portion of the tumour protrudes

SERIES XVII.]

ROUND-CELLED SARCOMA.

523

through the skin at the inner canthus ; another portion fills and
projects from the right nostril. In the cranium it forms an
irregularly lobulated mass, the size of a hen’s egg, in the anterior
cerebral fossa, covering the ethmoid, overlapping the orbital
plates of the frontal, and hollowing out the anterior cerebral lobe
in this situation. The consistency of the morbid growth is
everywhere soft ; it is homogeneous on section ; and consists of
small, round, nucleated cells, closely heaped together, and with
no formed intercellular structure but that derived from the
remnants of the invaded tissues. The tumour is therefore,
evidently, a round-celled sarcoma.

5. Malignant tumour involving the lower ends of both bones of the

right forearm of a native male (Hindu), aged 20.

“ The disease began a year ago, but has rapidly increased during the
last two months, and has also been very painful. The bones of
the forearm, at their lower third, are completely fused with the
tumour, and greatly disorganized. The carpal bones are also
found in a state of fatty degeneration,— cutting readily with
the knife. The joints are intact.”

This large tumour appears to have developed from the subperiosteal
tissue of both bones of the forearm, but particularly from that of
the radius. The periosteum, greatly stretched, and in parts imper-
fect, still forms a kind of capsule to the growth. The structure,
voider the microscope, consists of closely packed, round or slightly
oval, small, nucleated cells, having no intercellular material, but
heaped up irregularly in large loose masses. The consistency
is soft ; the vascularity great, (liound-celled sarcoma.)

Presented by Professor J. Fayrer.

6. A malignant tumour, situated on the posterior aspect of the right

forearm. From a Hindu boy, aged 10 years. Removed by
amputation at the lower third of the arm.

The tumour was of very rapid growth, and bled considerably from time
to time.

After amputation the patient did well, and was discharged from hospital.
He was readmitted, however, in four months’ time with three
small growths on the vertex of the skull, which were also sus-
pected to be malignant, but the friends objected to any further
operative interference, and the boy was removed.

The tumour of the forearm is oval in shape, flattened below where it
rests upon the deep fascia, from which, and from the subcuta-
neous cellular tissue of this part, it has apparently developed. The
bones of the forearm are not involved. The skin is closely and
intimately connected with the morbid growth, and in several
situations has ulcerated and allowed of the protrusion of the
tumour-tissue in the form of fungoid, lobulated masses. The
structure is for the most part purely cellular — small, round,
uniform, nucleated cells, with but scanty intercellular tissue.
In parts, however, there is a considerable admixture of fibrous
tissue, and a disposition of the latter in dissepiments or partitions
between lobules wholly composed of soft cellular elements. The

52 1

ROUND-CELLED SARCOMA.

[series XVII.

growth is undoubtedly malignant, — as was diagnosed during
hie,— and may be regarded as a round-celled sarcoma.

Presented by Professor H. C Cutcliffe.

V. A malignant (sarcomatous) tumour involving the upper part of the
right arm. From a native male (Hindu), aged 25. The growth
was ol eleven months’ duration. The arm was amputated at the
shoulder-joint.

this is a lobulated mass, the size of two fists, occupying the anterior
and outer aspects of the upper and middle thirds of the arm. It
does not involve the bone, but appears to have originated in the
intermuscular fasciae and connective tissues generally of this
part, invading the muscles, themselves and portions of the
integument also. The consistency of the growth is everywhere
soft ; in parts, just beneath the skin, this is still more marked
owing to inflammatory changes (suppuration, &c.). The cut
surface is lobulated, smooth, of a pinkish-white colour.

On microscopic examination the structure is densely cellular, the cells are nucleated,
rather larger than pus corpuscles, chiefly round,— a few spindle-shaped .’
No appreciable or “ formed ” intercellular substance exists. The growth
is a round-celled sarcoma.

Presented by Professor W. J. Palmer.

8. A preparation showing the vault of the skull perforated by a large

malignant tumour growing from the dura mater.

the right half of the frontal bone — including the orbital plate — has
been absorbed ; there is a gap thus left with sharp thin edges,
through which protrudes the morbid growth. The latter3 is
soft, ovoid in shape, about the size of an orange. It is attached
to the upper surface of the dura mater, in the median line,
and invested by a kind of pseudo-capsule formed by portions
of the pericranium and adherent occipito-frontalis muscle, — the
entire thickness of the bone between these structures externally,
and the dura mater internally, having been absorbed. The
tumour is slightly lobulated, smooth, and homogeneous on
section, reddish at the centre, paler peripherally.

Under the microscope, the structure is found to consist of cells about the same
size as, and also larger than, white blood-corpuscles (leucocytes), with large
single or double nuclei and nucleoli. No “ formed ” intercellular material.
Blood-vessels large, thin-walled, and very numerous. The growth is a
small round-celled sarcoma, and was diagnosed as such during life bv
means of exploration with a grooved needle.

the patient was a native (male), aged 40. On account of the nature
of the growth no operative interference was attempted. He
gradually became exhausted by hectic and pain. A secondary
development took place in connection with left femur, and
resulted in fracture of that bone — as discovered post mortem.
{See further, “ Surgical Post-mortem Records,” vol. I, 1878,
pp. 483-84.)

9. A round-celled sarcoma involving the bony and soft tissues on the

anterior aspect of the lower third of the right forearm. — From
a native male patient, aged 50.

“ The disease is said to have followed an injury'- to the parts affected,,
received about a year ago, and the present exuberant, semi-

SERIES XVII.]

ROUND-CELLED SARCOMA.

625

fungoid appearance of the growth has resulted from incisions
made into the tumour (four months ago) by a native barber.”

The tumour is about the size of an orange ; it is broadly lobulated ; the
surface brownish,— encrusted with much hardened sanguineous
discharge. On section, the consistency is soft, and the cut
surface blotched from blood-staining and extravasation. The
growth appears to have originated in the lower end of the
ulna, — the last two inches of which have been completely
absorbed. The radius is also involved, but not to so great an
extent, — its broad articular extremity is found hollowed out,
softened and disorganised. The carpal bones are not affected.
The tumour implicates all the soft tissues on the anterior and
ulnar side of the forearm.

Microscopically examined, the structure of the growth is highly cellular; the cells
are round or oval, and a few spindle-shaped; have large nuclei, and a
granular protoplasm. There is little or no intercellular substance, and no
stroma. The blood vessels are large aud numerous, — their longitudinal and
cross sections are observed tunnelling the soft cellular tumour-tissue in
various directions.

Presented by Professor K. McLeod.

10. A' subcutaneous malignant tumour (sarcoma) from the left dorsal

region (back) of a native female, aged 18, who died in hospital.
It was closely connected with the spinal muscles and fascise,
superficial and deep, and a small prolongation made its way
between the ribs into the cavity of the thorax. It is an ill-
defined, lobulated mass, and extended on the back from the
level of the spine of the scapula to the lower border of the last
rib, infiltrating the subcutaneous tissues widely and deeply.
Sections from both dorsal and intrathoracic portions of the
growth exhibit a highly cellular structure under the microscope.
The cells are uniform as regards size, are rounded or slightly
oval, possess one or two bright nuclei ; many are highly granular
from fatty changes. There is no intercellular formed material,
except here and there, where the disintegrating fragments of
invaded tissues (muscular and fibrous) are seen interposed
between groups or masses of the cell-elements. The growth
is very vascular, — permeated in every direction by large soft-
walled capillary vessels. There is no capsule,— the tumour-
tissue is lost amidst the surrounding normal structures, i.e., is
distinctly infiltrative in character. It is undoubtedly a round-
celled sarcoma. (See further, “ Medical Post-mortem Records ”
vol. Ill, 1879, pp. 384-85.)

11. A tumour involving the whole of the right forearm of a Hindu child,

aged 2£ years. Amputation of the limb just above the elbow-
joint was performed.

It is said to be a growth of twelve months, and to have commenced as
a small nodular swelling at the lower third of the anterior aspect
of the forearm. It now forms a smooth, oval-shaped mass
embracing the whole of the forearm,— from just below the elbow
to the wrist-joint, (neither the elbow nor the wrist-joint bein<>-
however, involved). It projects on both the anterior ami

526

ROUND-CELLED SARCOMA.

[SECIES XVII.

posterior aspects of the limb, and more on the ulnar than the
radial side. On a longitudinal section being made the struc-
ture and origin of the growth are revealed. It consists of soft,
brain-like, pinkish-white tissue, which has developed apparently
from the ulna, absorbing this bone almost completely, and then
infiltrating the surrounding soft parts both in front and behind
that bone, and extending across to the radial side of the
forearm. The periosteum of the bone — much thinned and
stretched — forms, in parts, a kind of capsule to the tumour, but
is incomplete or imperfect.

Microscopically, the structure of the growth is highly cellular; the cells are small,
round, and nucleated ; some are spindle-shaped. There is no stroma, no
intercellular “ formed ” material. Large blood-vessels permeate this tissue
in various directions, and the superjacent muscles and other soft parts,
where the pseudo-capsule is wanting, are infiltrated with a similar small-
celled growth,. The tumour is without doubt a round-celled sarcoma.

Presented by Professor K. McLeod.

12. A malignant tumour, of about eight months’ duration, removed
from the inner side of the lower part of the left arm, just above
the elbow.

Tho patient, Gopal, a Hindu, aged 34, stated that he first noticed a painful
swelling, the size of a small nut, at the bend of the elbow. It has gradually
enlarged during the past eight months, but has not been very painful.
The skin over the tumour has become discoloured and adherent to it ;
and the latter is not freely movable upon the subjacent soft parts. A
large indurated gland in the axilla was removed at the same operation.
No general hypertrophy of the lymph-glands exists. The patient is
liealthy-looking, and there is no hereditary or family history, and no history
of syphilis.

The tumour-mass is about the size of one’s fist ; lobulated in outline, —
this condition being well seen on section ; and its glandular origin
is distinct, even to the unaided eye. It is moderately firm, of
a pinkish-white, or, in parts, of a yellowish colour, and consists,
apparently, of a group of infiltrated and enlarged lymph-glands,
varying in size from a hazelnut to half a walnut, bound closely
together by soft fibrous tissue, and fixed to the superjacent
skin.

On microscopical examination, very thin and frayed out sections exhibit, in parts,
a delicate reticulum of connective tissue, with small, round, nucleated
cells. The reticulum, however, is in many sections quite absent. The
cells are uniform and granular, — exist in large numbers. The tumour
appears to be a lymplio-sarcoma, i.e., a round-celled sarcoma originating in
the lymph-glands at the bend of the elbow.

The growth recurred at the upper part of the wound before the latter
had quite healed. A considerable quantity of soft, nodular,
pinkish-white material was removed by a second operation (on
the 6th of June 1880). The infiltration, however, of the deeper
structures continued, burrowing along the intermuscular and
vascular structures of the arm as high as the axilla, — portions
of morbid growth being so situated as not to permit of
their being dissected out. The arm was therefore amputated

SEHIES XVII.]

ROUND-CELLED SARCOMA.

627

at the shoulder- joint (on the 15th June). Almost all the
axillary glands were involved, and there were prolongations
from the tumour-tissue inwards between the pectoral muscles,
&c. This tissue, re-examined microscopically, showed an almost
purely cellular structure ; the cells, as before, small, round, granu-
lar and nucleated. This structure, with the rapid recurrence
of the growth, and its highly infiltrative character, remove
all doubt as to its sarcomatous constitution (small round-celled
sarcoma.)

Presented by Professor D. O’C. Raye.

13. A malignant tumour (small round-celled sarcoma) of the right

arm, removed by operation (amputation at the shoulder-joint),
from a native male, aged 18. It is about the size of the foetal
head, and of about eight months’ duration.

The tumour is somewhat ovoid in shape, and surrounds tho upper turn-
thirds of the shaft of the humerus. It implicates the surround-
ing soft parts, and the skin over it has ulcerated in four or five
places, permitting thus of the protrusion of portions of the
growth in fungoid form. On a longitudinal section being made
through the bone, the development of the tumour is seen to have
taken place from the periosteum of the upper and middle thirds
of the shaft, while, at the centre of the latter, the growth has
made its way into the medullary canal, and an apparently spon-
taneous fracture of the whole thickness of the bone has taken
place at this situation. The consistency of the tumour is soft
and succulent ; it is throughout highly vascular, and presented,
in the fresh state, a rosy-pink colour, with blotchings and dark-
purple blood-extravasations in different parts.

Examined microscopically, the structure is highly cellular. The cell -elements
are uniformly small and round. There is no intercellular tissue or stroma ;
and the muscular and other soft tissues of the arm are found diffusely infil-
trated. The morbid growth is, therefore, a round-celled sarcoma.

Presented by Professor K. McLeod.

14. A lobulated tumour, the size of the foetal head, involving the

right half, the symphysis, and a portion of the left half of the
lower jaw, which has been extirpated by disarticulation of the
right condyle, and division of the bone just beyond the left first
molar tooth.

On section, the tumour substance is soft, and markedly alveolated or
cystic-looking— the alveoli being chiefly formed by expansions of
the sockets of the teeth, the growth involving the interior of the
bone as well as surrounding it, and implicating the muscles
skin, and soft structures generally. No history.

Microscopically examined, the structure of the tumour is highly cellular;— the cells
large, rounded or oval, nucleated, lying close together in masses’ in a kind
of alveolar stroma, closely resembling soft cancer except in the more uniform
size and shape of the cellular constituents, and therefore, probably, to be
regarded, more strictly, as alveolar sarcoma.

15. A large fungus-looking growth involving the skin and subcuta-

neous tissues on the inner aspect of the right hand. The growth
reaches and partially invades the fifth metacarpal bone,— ?n fact

528

ALVEOLAR SARCOMA.

[series XVII.

appears to have originated from the periosteum covering it or
trom the superjacent connective tissue. The tumour Is very
vascular,— the vessels forming large loops and plexuses in various
directions throughout its substance. The latter is remarkably
solt and cellular. The cells are large, round or oval, uniform as
regards size, and contain single, distinct and prominent nuclei.
Is o stroma exists.

I.lie normal papillae of the skin are much exaggerated, and their
epithelia in a state of proliferation, but not extending below
the papillary layer of the cutis vera.

I be giowth is a large-round-celled or alveolar sarcoma.

P resented by Dr. Herbert Baillie.

16. A laige tumour involving the whole of the soft parts on the
femoral aspect ol the knee-joint” (left), “and also those sur-
loundmg the anterior and lateral aspects of the inferior third
of the femur. The interior of the knee-joint is also implicated.”

i f * • # f # “ -^ie bone, part of which is

denuded of periosteum, is roughened and somewhat cribriform
m the lower two inches of the shaft and inferior extremity.
1 osteriorly, large nodules are seen filling up the popliteal space,
and displacing the healthy parts in that region.” (Ewart.)

Ihe structure of the growth is highly cellular under the microscope, — the cells are
large,, almost “epithelial” in character, have large, single or double
nuclei, i hose situated in the deeper strata of the tumour-tissue are
round; more superficially or peripherally, they are spindle-shaped. All are
closely packed together, with little or no trace of any intercellular
structure. All the soft tissues surrounding the knee-joint and femur—
the ligaments, muscles, fasciae, &c.— have been implicated. The tumour is,
evidently, an alveolar sarcoma. (J. F. P. McC.)

Presented by Professor J. Fayrer.

17. A slightly lobulated tumour, removed from the left parotid region

of a Mahomedan, aged 26. It is about the size of an orange,
and was said to be a growth of about two years, — slow and
painless at^ first, but very rapid and painful during the last six
months. The tumour is invested by an incomplete or imperfect
capsule of connective tissue, and is, for the most part, smooth
and homogeneous on section.

1 ho structure, microscopically, consists principally of cells about twice or three
times the size of blood-corpuscles, round, granular, and with generally a
single, large, central nucleus. There is very little intercellular material,
and that which exists is composed of delicate filaments of connective
tissue, forming an indistinct and irregular stroma. The cells are throughout
uniform in shape (round or oval) ; a few are almost as large as epithelial
cells. The tumour appears to be a round-celled sarcoma of the larger-
celled variety ( alveolar sarcoma).

Presented by Professor H. C. Cutcliffe.

18. Large round-celled sarcoma. A growth about the size of one’s

fist, removed from the right groin of a young native adult, and
said to have been of only three months’ duration. The mass
looks at first sight as if composed of a series of enlarged and
coherent lymphatic glands, but on closer examination it is

SEHIES XVII. ] - ALVEOLAR SARCOMA. 529

observed that the glandular appearance is confined, for the most
part, to the peripheral portions, while, at the centre of the
growth, there is a smooth, soft, pinkish-white nodule, about the
size of a hen’s egg, which, in the fresh state, was deeply blood-
stained and of a dark red colour, especially where it has ulcerated
through the superjacent skin.

This growth, examined microscopically, consists of large round cells, approaching
the epithelial type, with one or two large nuclei, and a granular protoplasm.
They lie close together, without any stroma or alveolar arrangement, or hut
faint traces of the same. At the periphery, the nodule (which itself has
probably originated in a lymph-gland) is blended with a series of soft and
succulent lymphatic glands (the inguinal). In them their proper adenoid
structure is quite distinct, and is quite different from that of the central
mass, although here and there transitional changes are observed, — the cells
becoming larger, the intercellular reticulum softening, &c. The tumour is
undoubtedly malignant, and of the type known as large round-celled or
alveolar sarcoma.

19. A malignant tumour (sarcoma) of the right leg. From a native

male patient, aged 19. It is said to have been a growth of only
about three months’ duration. The glands in the groin were not
enlarged or indurated. The patient was weak and much
emaciated. The morbid growth consists of an irregularly ovoid
fungating mass surrounding the upper third of the leg, and involv-
ing the skin and soft parts down to the bones, which are super-
ficially necrosed and wasted, the tibia showing also some conden-
sation of the cancellous structure of the head, but a highly fatty
condition of the medulla. The substance of the tumour is very
soft ; composed of pale-pink or pinkish-white nodules of varying
size, with intervening broad, flattened infiltrative growths.
There is no capsule, and no strict definition or limit to the
tumour. The superior epiphysis of the tibia has separated from
the shaft, but the knee-joint does not appear to have become
involved.

Microscopically examined, the structure is highly cellular. The cells are somewhat
large, — two to three times the diameter of a blood-corpuscle, — are round or
oval, — a few spindle-shaped, — and contain single, large, prominent, and very
distinct nuclei, occupying a considerable portion of the protoplasm. The
growth is therefore, undoubtedly, a largo round or oval-celled sarcoma.

Presented hj Professor D. O’C. Raye.

20. Extirpated eyeball, showing complete disorganisation of the globe,

and the presence of a soft, pale-yellowish growth (partly
detached), developing in the vicinity of the optic nerve,
and involving the sclerotic coat, — a glioma. Its structure con-

sists of small round, more or less uniform, nucleated cells,
about the size of leucocytes, with a scanty, fibrillated, intercellu-
lar tissue, — interspersed with broader bands of fibro-elastic
tissue, derived apparently from the sheath of the optic nerve,
and from the sclerotic coat, which serve to map out the substance*
of the tumour into small divisions or lobules.

21. Glioma of the eyeball, in parts pigmented. The globe is disorgan-

ised ; the new growth fills the ocular cavity, and covers about
two-fifths of the posterior surface of the sclerotic, on either side

530

GLIOMA.

[SEEIES XVII.

of the optic nerve. In this situation it appears to have originat-
ed. The sti ucture consists of small round or slightly angular
cells, closely packed together, with a delicate fragmentary and
imperfect stroma of connective tissue. The cells are nucleated,
and many of them darkly pigmented.

Presented by Dr. Herbert Baillie.

22. A tabulated growth, the size of a small orange, removed, together

with the disorganised eyeball, from a native child aged two-and-
a-half years, . It had been growing for only two months. The
greater part of the growth surrounds the optic nerve and sheath,
and the posterior two-thirds of the sclerotic coat. Towards the
anterior aspect of the eyeball a rounded, soft, spongy, fun«-Us-
like protrusion exists.

Sections made through different, portions of the mass exhibit, under the
microscope, a very highly cellular structure. The cells are* the
size of white blood-corpuscles, mononucleated, slightly granular,
mostly round, a few angular or otherwise distorted. These are
heaped together without any very definite arrangement, and
separated by a very scanty fibrillated connective tissue,— no true
stroma. A large quantity of blood-pigment (hsematoidin)
granular and reddish-brown, free or contained by certain of the
cell-elements— also exists. The sheath of the optic nerve and
the sclerotic appear to have been the matrix or site of origin
of the growth, which has, subsequently, by pressure, destroyed
the structure of the eyeball. The tumour is a true glioma.

Presented by Professor H. Cayley.

23. A tumour of the orbit ; removed from a native child. It is an

ovoid mass, the size of one’s fist ; very soft and pulpy in consist-
ency. On section, a more or less homogeneous, pinkish-white
surface is presented, giving a brain-like appearance to the growth.
In parts it has a dark-red or purplish colour from blood-staining
and extravasation. A thin rim of dense white fibrous tissue
represents the remains of the sclerotic coat ; no trace of the
other structures of the eyeball can be identified. The growth
seems to have involved the whole of the globe, and also the
muscles, cellulo-adipose tissue, &c., filling up the rest of the
orbit.

On microscopical examination, it proves to be a glioma ; consisting of
small, round, nucleated cells, scarcely larger than leucocytes,
closely packed together ; but, on careful brushing-out under water,
a very delicate connective tissue reticulum can be distinguished ;
this in parts is well formed, in others is itself immature. There
is no trace of any cancer structure.

Presented by Dr. E. Lawrie.

24. A tumour from the orbit of a native child, with also the extir-

pated eyeball. The latter is entire but soft, and partially
disorganised, with — in the fresh state — an opaque, yellowish-
white soft cataract visible through the transparent cornea.
The optic nerve is not involved, but its sheath is vascular,
thickened, and slightly adherent to a portion of the soft, pinkish-
white growth, which is intimately connected with the posterior

SEBIE9 XVIl]

SPINDLE-CELLED SARCOMA.

631

surface of the sclerotic coat. This growth or tumour is alto-
gether about the size of a walnut ; it has no capsule, and no
strict definition.

Examined microscopically, is seen to consist of small, round, nucleated
cells, with a scanty, fibrillated, intercellular tissue, and through-
out highly infiltrated with granular and molecular fat. It
appears, therefore, to be a glioma.

Presented by Professor H. Cayley.

25. A small-celled, spindle-celled sarcoma, “ removed from the leg.”

This is an irregularly rounded and lobulated tumour, possessing
also a somewhat fungoid appearance. Its structure, under the
microscope, is highly'- cellular ; the great majority of the cells
are very small, narrow, and spindle-shaped ; grouped together
without any intervening “ formed ” material. Intermixed with
these are small round cells. They all contain rounded or oval
nuclei, single or double. No history.

26. A large, lobulated tumour, of soft consistency, “ removed from
the arm.” No history. The structure is densely cellular. The
cell-elements are large, spindle-shaped, mononucJeated, closely
heaped or applied to each other, and without any intercellular
tissue. The tumour is therefore a spindle-celled sarcoma.

27. The left foot showing the presence of a rounded ulcerating growth,

situated on the inner aspect of the tarsus, and encroaching upon
the sole. It involves all the soft parts in this situation, but not
the osseous structures of the tarsus or metatarsus. It is soft in
consistency, smooth and homogeneous on section, and, under the
microscope, exhibits a very highly cellular structure. The cells
are spindle-shaped, with large nucleolated nuclei, have no proper
intercellular substance ; no stroma. With these are round cells
of the same character. There is no limiting capsule. The
tumour or growth is a spindle-celled sarcoma.

Presented by Professor J. Fayrer.

23. Amputation of the right leg for a fungus-looking growth situated
over the anterior and outer aspects of the lower third of the
limb. It involves all the soft tissues, including the skin, and
reaches the osseous structures below ; is smooth and homoge-
neous on section ; succulent and soft in consistency ; highly vas-
cular. Consists of small spindle-shaped cells, with round or
oval, large nuclei; small round nucleated cells are also found, and
in parts a development of very fine or delicate and immature
connective tissue, but the great bulk of the growth is made up
of spindle-cells, and it is evidently a sarcoma of this variety.

Presented by Professor S. B. Partridge.

29. “ Large osteo-sarcoma of the right ulna. The bony shell of the

tumour is deficient anteriorly, and so thin behind that it has
been cut through in two or three places. Within is a cavity,
the walls of which are lined by pultaceous matter. Case of
Ilari Sircar.” (Colies.)

The morbid growth is a sarcoma. It consists of small, elongated, spin-
dle-shaped and nucleated cells — closely packed together, with
scarcely any intervening substance, and no true stroma. The

532 SPINDLE-CELLED SARCOMA. [series xtii.

whole of the superior extremity of the ulna is implicated, and the
tumour forms an irregular shaped mass as large as one’s fist.

30. A preparation showing a large fungoid growth (4|" x 3" x 1|") ;
ovoid in shape, lohulated, and of soft consistency, — situated
behind and to the right of the urinary bladder, which it separates
from the rectum and levator ani. The tumour presses upon and
causes a forward bulging of the posterior wall of the bladder,
— above and a little to the right of the trigone.

Examined microscopically, the structure is found highly cellular, — con-
sists of round and spindle-shaped nucleated cells, the latter pre-
dominating. The nuclei are large, and many double. There is
a faintly granular intercellular substance, but no stroma. The
growth is undoubtedly a spindle-celled sarcoma.

The preparation includes the bladder, urethra, rectum, and both kidneys of a
native male patient (Denoo), who was admitted into hospital with a
hypogastric tumour of six months* growth, and which first attracted his
attention from causing a difficulty in voiding, and sometimes complete
retention of urine. The mass, on admission, reached to two inches above
the umbilicus, and ‘‘ except that it was flatter and inclined towards the right
side below, resembled an enormously distended bladder.” The bowels were
constipated. The patient passed urine in only small quantities. A large
catheter could easily be passed down the urethra, but at first only evacuated
from two to eight ounces of urine, and never appeared really to enter the
bladder. Pus and blood came away with the urine ; the latter in sufficient
quantity to clog the catheter. The man eventually died of peritonitis.

On post-mortem, examination, the bladder was found adherent to the linea alba, and
distended with about 12 ounces of clear, not foetid, urine j no blood.
“ From the elevation of the las fond so high in the abdomen, the fundus
was obliterated, and the neck of the bladder stood at the lowest point of a
funnel-like prolongation of the viscus.” The mucous membrane was
health^^JThe urethra was also normal, until the prostatic portion was
reached: from this part, which was somewhat dilated, “ two passages
led, — one, upwards and backwards to the left, *’ where an
abscess, containing about an ounce of pus, was found in the cellular
tissue around the neck of the bladder ; “ the other, upwards and

backwards to the right into the substance of the growth.” * * * *

“ Through the passages above mentioned (evidently the prostatic ducts in
an altered state), the pus and blood which passed on catheterism must
have escaped. It is probable that when the lower funnel-like portion
of the bladder leading to the neck was emptied by the catheter,
the portion of the tumour which caused the posterior wall to bulge,
became more prominent, so as altogether to cut oil' the greater portion
of the bladder from the urethra, and prevent its being emptied/*
******* “ The prostate was found softened, — almost

diffluent. The rectum healthy. The kidneys showed expansion of their
pelves and calyces, with corresponding atrophy of the secreting
structure/* * * * * * “ The peritoneum contained a

considerable quantity of dark brown serum with flakes of lymph, and had
patches of recent false membrane on it in several places.” (Colics.)

Presented by Professor J. Fayrer.

31. “ Large fibro-plastic tumour, removed from the outside of the left

upper arm of a Mahomedan (Aga Alii), aged 28. It was
subcutaneous. At one point had begun to ulcerate, and bled
freely. Under the microscope, it consisted of nucleated cells,
some oval, others fusiform, and by their aggregation producing

SEBIE8 XVII.]

SPINDLE-CELLED SAKCOMA.

633

a fibrillated structure, which still falls far short of regular
fibrous or connective tissue.” (C'olles.)

Re-examined microscopically, the tumour is found, as described, fibro -plastic, or,
more correctly speaking, a small-celled, spindle celled sarcoma. (J . F. P. McC.)

32. An enormous lobulated tumour surrounding the lower two-thirds

of the left femur, and involving all the soft parts down to and
including the periosteum, but not the bone. The latter, as
may be seen from the longitudinal section which has been made,
is fairly healthy in structure. The consistency of the tumour
mass is very soft, and its vascularity very considerable — (this
has been well demonstrated by the artificial injection of the blood-
vessels with red paint). Under the microscope the structure
consists of round and fusiform cells, the latter predominating.
They are from two to three times as large as blood-corpuscles,
and each contains a well-developed nucleolated nucleus. — The
growth is a gigantic spindle-celled sarcoma.

From a native male patient (Motee). The thigh was amputated at the
hip-joint. The growth of the tumour “ is said to have followed
the prick of a thorn.”

Presented by Professor J. Fayrer.

33. A small-celled, spindle-celled sarcoma (“ fibro-plastic ” or

“recurrent fibroid ’’tumour), removed from “the foot of a
European.” It is ovoid in shape, about 3" X 2^' X 1" ; a portion
of the skin adherent on one side. On section, it is smooth,
homogeneous, soft in consistency, of a dull brownish colour.
It consists principally of small, elongated or fusiform cells',
numbers having bifid prolongations, or are tripolar or oat-shaped.
They contain large nucleolated nuclei.

Presented by Professor J. Fayrer.

34. “ A large fibro-nucleated tumour removed from the upper part of

the left forearm. It was attached by a broad base to the
cellular tissue among the muscles. The tumour is kidney-
shaped, hard below and soft above ; weighs 15|- ounces. It was
two years and a half growing, and had increased rapidly during
the last twelve months.” (Colies.)

The structure, under the microscope, is seen to consist of small spindle-shaped
or oat-shaped nucleated cells, lying closely packed together, and only
separable by careful brushing out of thin sections under water— (sarcoma.)

Presented by Professor J. Fayrer.

35. A tumour involving the lower third of the ulna, which portion

of the bone has been excised en masse. The radius was not
involved, nor the superjacent soft tissues. From a native male
aged 20. It is said to have commenced as a small localised
swelling of the bone, 18 months ago. The lower third of the
ulna presents a sliglitly nodulated appearance, and is expanded to
the size of an orange. On section, the morbid growth is seen
to have originated in the medullary canal or cancellous tissue
and to have increased so as to expand the bone around it, until
it forms (see preparation) a kind of egg-shell covering or cyst

534

SPINDLE-CELLED SARCOMA.

[SEKIES XVII. |

with very thin and brittle walls. The tumour tissue is soft,
pinkish -white, infiltrates the bone very thoroughly, and even
protrudes in parts through the osseous shell, so as to lie just
beneath the periosteum. The latter is greatly stretched, but
remains entire over the whole of the expanded shaft of the ulna.

The structure of the morbid growth is densely cellular no intercellular “ formed ”
tissue appearing even after repeated careful washing and brushing out of
thin sections. The vast majority of the cells are small and spindle-shaped ;
with these are mixed up small round cells, like granulation corpuscles, and
a few large “ myeloid " cells. The bulk of the growth, however, consists of
small oat-shaped or fusiform cells, with single nuclei, heaped together
without any intervening substance, except a little granular amorphous
material. The tumour is, therefore, a true small-celled, spindle-celled sarcoma.

Presented ly Professor S. B. Partridge.

36- A large fungating malignant growth involving the skin, subcutane-
ous soft tissues, and tarsal bones on the inner side of the left foot,
and necessitating amputation at the lower third of the leg. The
subject was a native male, aged about 50, The tumour had been
growing rapidly for the last eight months.

It consists of an oval shaped ulcerated mass, about 2|" in diameter, with
several soft, brownish-coloured (blood stained) nodules forming
a kind of fungous protrusion from its surface. The internal
cuneiform and base of the first metatarsal bone are implicated, —
the former being hollowed out and carious. The other bones of
the tarsus and metatarsus are found healthy on longitudinal
section of the foot.

Examined microscopically, the growth proves to be a small-celled ,
sp in die- celled sarcom a.

Presented by Professor W. J. Palmer.

37. A malignant tumour (sarcoma) of the left thigh, of five months'
duration. — From a Mahomedan boy, aged 9 years. Amputation
performed at the hip-joint. On a longitudinal section being made
through the whole thickness of the bone, the morbid growth is
seen to consist of a pinkish-white, somewhat soft mass, occupying
its middle two-fourths. The superior and inferior epiphyses
are not involved, nor the immediately adjacent portions of the
shaft, though the cancellous tissue in these situations is abnor-
mally vascular and friable. The true tumour-tissue seems to
have developed from the medulla, filling and distending the
canal, and then encroaching upon the compact tissue of the
walls (shaft), so as gradually to destroy the osseous laminae and
reduce the bone to a mere shell. Here and there, isolated nodules
of bone — which have apparently escaped disintegration — are found
imbedded in the soft tumour-mass. The latter does not extend
beyond the expanded shaft ; does not reach or infiltrate the
muscles and other superjacent structures. The whole growth
forms an oval-shaped tumour about 6" in length, 3|" in breadth,
and 8" in circumference.

Examined microscopically, it consists chiefly of very small, narrow, spindle-shaped,
nucleated ceils, which lie close together, i.e., without any formed intercell-
ular substance. Some round cells are also found, and a few giant, multi-

SEBIES XVII.]

SPINDLE-CELLED SAKCOMA.

535

nucleated myeloid cells, but small fusiform cells predominate, and the
tumour is evidently a spindle-celled sarcoma.

Presented by Professor W. J. Palmer.

38. A large lobulated tumour, removed from the right submaxil-

lary region of a native female, aged 30. The floor of the
mouth was displaced upwards, and the lower border of the inferior
maxilla, near its angle, was flattened and adherent to the growth.
A portion of the superjacent skin, with three ulcerated openings,
may be seen on one side of the tumour, the rest being invested
by an imperfect and delicate capsule of connective tissue. It is
soft, pulpy, brain-like in consistency ; here and there blotched
crimson or purple from blood-staining. Traces of glandular
structure are found on microscopical examination, but the main
bulk of the tumour consists of large spindle-shaped cells, with
oval nucleolated nuclei, and a granular highly fatty protoplasm.
With these are cells both oval and round, and also numbers of
large, giant-cells (myeloplasts) with multiple nuclei, but the
spindle-cells predominate. The growth is undoubtedly a spindle-
celled sarcoma , originating in the submaxillary or other gland
structures.*

Presented by Professor K. McLeod.

39. A malignant tumour of the right leg. The patient, a native 'male

(Hindu), aged 25, weak and emaciated, “ stated that about four-
teen months ago he had a fall and injured the leg. The upper
part of the limb inflamed, and a swelling, the size of a hen’s egg,
appeared in the course of a few days. He punctured this and
then applied some “ blue-stone.” An ulcer resulted, but the
swelling did not subside ; on the contrary, it has increased
rapidly, and has given great pain.”

On the inner and anterior aspect of the head of the tibia, just below the
knee-joint, there is a large fungating growth, which protrudes
through and involves the skin, and had (in the fresh state) a bright
pink or pinkish-yellow colour. On longitudinal section through
the bone, the whole of the cancellous tissue of the head and about
the upper third of the medullary canal are found occupied by
tlie morbid growth, which has the same general appearance here
as at the surface. It is very soft in consistency, and is com-
posed (as seen under the microscope) of large round and spindle-
shaped nucleated cells, with no formed intercellular substance ; no
stroma ; and no capsule. The knee-joint is not implicated ;
but the deeper layers of the articular cartilage are found in
a state of active proliferation, and thinned. The fibula remains
healthy. The upper part of the medullary canal of the tibia is
expanded. The medulla itself has a bright-pink colour, and is
abnormally fatty. The growth is a spindlc-cclled sarcoma of
the large celled variety. It has probably originated in the can-
cellous tissue of the head of the tibia or in the medullary
canal, and, expanding the bone around it, has made its appearance

* This tumour recurred in situ in less than a month, and an exuberant nodule of sarcoma

tous growth in the cicatrix, together with the greater portion of the parotid gland which had*

become involved, were removed by a second operation. (J. F. P. McC.)

MELANOTIC SARCOMA. [series xvii.

as a fungoid mass on the anterior and inner aspects of the
leg, — the skin having ulcerated.

Presented ly Professor D. O’C. Raye.

40. A tumour surrounding and involving the sheaths of the common
carotid artery and its branches on the right side of the neck,
and removed with these vessels en masse. It deeply infiltrated
the surrounding and subjacent structures, and was said to be
of eight months’ duration.

The preparation exhibits an irregularly-defined growth, somewhat
tabulated in outline. It embraces the carotid vessels, and
appears to have originated in one or more lymphatic glands
in this situation. A portion of the right lobe of the thyroid
body, which seemed to be involved in the growth, was excised
at the same time. The structure, microscopically, is that
of large spindle-celled sarcoma — very rapidly proliferating.
There are some round cells also, but the predominating variety
is the nucleated fusiform cell, with markedly granular proto-
plasm, and no stroma or intercellular material, except, here and
there, strands of fibrous tissue and lymphoid or glandular
structure — disintegrating, or undergoing sarcomatous transform-
ation. The sheath of the vessels (common trunk and external
and internal carotids) shows similar changes, i.e., distinct infil-
tration.

A portion of the internal jugular vein was removed with the tumour, and
portions of the submaxillary and parotid glands. The pneumo-
gastric nerve was cleanly dissected out, but left in situ. The
patient, a native male (Hindu), aged about 40, survived the
operation only a few hours.

Presented ly Professor K. McLeod.

41. Melanotic sarcoma of the palm of the right hand. “A section

shows the deep black colour of the substance of the growth. ”
The tumour has the shape of a flattened sphere, and is the size of
a small orange. It originates, apparently, from the true skin
of the palm of the hand. On microscopical examination, the
cutis vera is not simply hypertrophied, nor shows any splitting
up into stroma, but, together with the subcuticular layer, is
developed into a mass of large, elongated, spindle-shaped cells,
with prominent oval nuclei. The majority of these cells contain
dark pigment matter in granular form, affecting or infiltrating
chiefly the protoplasm, but in many the nuclei also. There is
no distinct intercellular substance. The consistency of the growth
is soft. The structure, therefore, is typically sarcomatous, — the
pigment being probably derived from the rete mucosum of the
skin.

History, — “ Bama, a Hindu servant, aged 26 years, was admitted into the Native
or Clmndnee Hospital on the 13th May 1864. Slio is a spare, healthy-
looking young woman, and states that the disease commenced spontaneously
four months ago, by a small vascular brown -looking painful tumour upon
the middle portion of the palmar surface of the third metacarpal bone of the
right hand. It gradually increased, and has now attained the size of
a sliced apple, occupying nearly the whole of the palm of the hand. The

SERIES XVII.]

MYELOID SARCOMA.

537

motions of the fingers are not affected. The stump healed up kindly,
and the patient left the hospital with it perfectly cicatrized.”

Presented by Dr. Herbert Baillie.

42. A melanotic growth (sarcoma) removed from the outer side of

the left heel of a native male patient, aged 35. It is said to
have been of two years’ duration. The growth forms a flattened
somewhat lobulated mass, 2\" involving the true

skin and upper layers of the subcutaneous tissues. Examined
microscopically, traces of degenerated epithelial scales can be
found at the periphery, but the great bulk of the growth consists
of small round and spindle-shaped nucleated cells, — the latter
predominating. For the depth of about half an inch there is
much dark granular pigment deposited within these cells ; below
this they are free from colouring matter, but are seen infiltrating
the normal subcutaneous tissues in various directions. The
tumour must therefore be regarded as a melanotic spindle-celled
sarcoma , taking its origin or developing from the cutis vera of
the heel of the foot.

Presented by Professor H. C. Cuteliffe.

43. Myeloid sarcoma. “Left forearm of Jliooloor, a Monda, aged

34, — amputated above the elbow for a tumour of twelve months’
growth.”

“ The tumour involves the lower third of the forearm. Anteriorly, the
skin has ulcerated and a large fungus protrudes. Posteriorly,
over the lower end of the radius, the tumour forms a huge mass,
larger than the clenched fist,— superficially hard and dense, —
from the lower and outer end of which a soft fluctuating growth,
the size of a small apple, — projects subcutaneously. On the lower
and back part of this may be seen the mark of paracentesis
performed before amputation, which only gave vent to blood.”
(A glass rod indicates the site of puncture.) “ The radial artery
was considerably enlarged in this case. The fingers were free,
and there was but little pain, or affection of the glands.”

“The tumour has been laid open, and the remains of the radius bisected
from behind. A large cavity is now seen, with bony walls T1-"
thick, and continuous above with the medullary cavity of the
radius, the lower end of which is expanded and softened, but
has a defined edge which projects into the cavity of the tumour.
The bony wall of the latter is deficient anteriorly, where it com-
municates with the fungating ulcer on the front of the forearm
and behind and externally (near where the styloid process should
be) there is a small oval opening leading to the ‘soft fluctuating
tumour on the back of the wrist.” (Colies.)

Examined microscopically, the structure of the tumour is highly cellular. The
cells are small, round or angular, with large distinct nuclei ; they lie close
together, have no formed intercellular substance; and, with these, are
large numbers of polynucleated giant-cells, giving a very characteristic and
typical appearance to sections taken from various portions of the growth.
The tumour is undoubtedly a myeloid sarcoma. (J. F. P. McC.)

Presented by Dr. Brownlow Hyatt, Ranchee, Chota Nagpore.

538

MYELOID SARCOMA.

[series XVII.

44. A myeloid epulis of the lower jaw. The growth involves a
considerable portion ol the transverse ramus, including the
symphysis. This portion — extending from the first right bicus-
pid to the last left molar- — has been removed with the tumour.
The latter consists of two rounded, ridge-like eminences, with a
deep furrow between them. The smaller, placed posteriorly, displays
on section, a narrow ring of bone— (the expanded jaw), enclosing
an opaque, dull-white, fibrous-looking substance. The larger
and external or anterior prominence is purely fibrous-looking,
and appears to be an expansion or development from the peri-
osteum and gum.

On microscopical examination, the structure of the whole growth consists of small
round and spindle-shaped mononucleated cells, intermingled with large
giant-cells having multiple nuclei. There, is no intercellular substance no
stroma. The characters are those of true myeloid sarcoma.

The subject was a Hindu, aged about GO. He had enjoyed fairly good
health to within the last six months. The tumour was of eight
months’ duration. It was first noticed as a small excrescence
from the gum on the inner aspect of the symphysis, and had
increased rather rapidly. The patient died from pysemia, and
the rest of the jaw was removed post mortem , and has been
preserved with the morbid growth.

Presented by Professor J. A. P. Colles.

45. A myeloid sarcoma of the left forearm. From a native female,

aged 25. The tumour is of eight months’ growth. “ It is said
to have followed fracture of the bones of the forearm — the result
of a fall.” Was growing very slowly at first, and without pain,
but latterly has increased rapidly and has been very painful.
Amputation of the limb through the elbow-joint was performed ;
the greater portion of the flaps sloughed, and the humerus
became exposed ; the latter was resected, and fresh flaps con-
structed ; these mostly united, but osteomylitis of the humerus
having been set up, amputation at the shoulder-joint had to be
performed, and eventually the patient died of pyaemia.

The tumour is irregularly rounded, and slightly lobulated, — the size of
a large orange. It is closely adherent to the skin, but has
developed chiefly from the ulna, though implicating the adjacent
margin of the radius also, and the surrounding soft parts.

Examined microscopically, exhibits numerous large myeloid cells with multiple
contained nuclei, and a very large number of fusiform or caudate nucleated
cells. These are massed together with very little or no intercellular sub-
stance. The growth is therefore a true sarcoma (myeloid.)

Presented by Professor II. C. Cutcliffe.

46. A myeloid tumour removed from the left side of the upper jaw

of a native male, aged 50.

The tumour came away pretty readily, and did not seem to infiltrate
the surrounding soft structures to any appreciable extent. It
equals in size an orange, and has an irregular nodulated surface.
When fresh, the section presented a glistening, semi-transparent

SERIES XVII.]

MYELOID SABCOMA.

539

appearance, but with numerous minute ecchymoses and blotches
of blood, of pinkish and purplish tinge. The lobules of
which the growth is composed are united together by very
delicate fibro-cellular tissue, and the entire mass invested by a
moderately dense capsule of the same structure. The consist-
ency is very soft.

Under the microscope, the growth is seen to he composed of small round and
angular cells, with single, distinct, large-sized, nucleolated nuclei; and
numerous brood cells, having a finely granular protoplasm, and containing
ten, twenty, or thirty large round nuclei (myeloid cells). Very little inter-
cellular material exists, and that is chiefly granular and soft, except in the
neighbourhood of the fibrous partitions which surround and separate the
several nodules of which the tumour at its periphery is composed ; — here,
delicate connection tissue fibres, diverging or radiating from the capsule,
can be traced for a short distance into the tumour-substance. These hands
are dotted with atrophied round or angular cells, free nuclei, and fat
globules and granules. The growth ia a very excellent example of a
myeloid sarcoma.

Presented by Professor H. C. Cutcliffe.

47. Myeloid tumour of the upper jaw. From a native boy, aged 11

years. “ It is of about IS months’ growth, and appeared
at first like a pea at the inner aspect of the upper lip.
Increased slowly until the last six months, during which period
its increase has been rapid and very painful.”

The preparation consists of a portion of the alveolar border of the
right superior maxilla, and the anterior half of the hard palate.
The growth involves the whole of the former, developing
apparently from the gum, and has made its way upwards and
outwards into the nostril and antrum. It is markedly lobulated,
has a smooth but mottled surface, a thin delicate capsule of
connective tissue, and on section is soft and variegated in colour,
— in parts yellowish-white, in others pinkish and purplish from
blood-staining.

U nder the microscope, the structure is highly cellular. The cells are round and
spindle-shaped ; the former about twice the size of a blood-corpuscle, the
latter larger. All possess distinct, nucleolated nuclei of considerable size.
Amidst such cells are a great many myeloid or giant-cells, polynucleated,
and of various shapes, with many-tailed processes or prolongations. These
give the characteristic type to the growth, which is undoubtedly a myeloid
sarcoma. The capillary vessels are numerous and thin-walled.

Presented by Professor D. O’C. Kaye.

48. A large fungating tumour of the testicle.— The superjacent skin

is ulcerated and the growth protrudes in several places. The
peripheral portion of the tumour is soft and spongy in character ;
towards the centre are a few nodules, very dense, fibroid, and
even cartilaginous in character.

Under the microscope, the structure of the growth is mixed or complex.
The tubuli seminiferi are found either entirely collapsed and
disorganised, or, in other parts, much dilated, their lining
epithelium in a state of proliferation, and even forming small
nests towards the centres of some tubules, from mutual compres-
sion. External to the tubules, and comprising the great bulk of

540

MIXED SARCOMA.

[SEEIES XVII.

the diseased mass, is a very abundant round-celled nucleated
growth. In parts again, the structure is purely fibrous or
fibroid, — consisting of closely interlacing hands of connective
tissue; and lastly, here and there, small nodules of true
cartilage are found. The tumour is probably, therefore, a
mixed sarcoma. No history.

Presented by Professor Allan Webb.

49 A large lobulated tumour removed from the upper part of the
popliteal space of a Hindu male, aged 30. It has an imperfect
capsule of fibrous tissue. On section is soft, in parts creamy,
in others has broken down to form pseudo-cysts. Its structure,
under the microscope, consists of small round and fusiform cells,
with bright transparent nuclei, — the lobules connected together
b}r a variable amount of fibrous tissue. In parts, the elements
are strictly round, or but slightly oval, and contained in a small-
meshed stroma, indicating true lymphoid tissue ; in others, this
reticulum is lost, the cells exist without any intervening formed
tissue, are extremely numerous, and exhibit a tendency to become
fusiform or spindle-shaped. The growth is therefore a lympho-
sarcoma, or a sarcoma that has had its origin in the normally
existing lymphatic glands of the popliteal space.

The growth recurred in less than four mouths, necessitating amputation of the
thigh at the middle third.

Presented by Professor J. Fayrer.

50- A fibro-sarcomatous tumour, removed from the right scapular region
of a native female, aged 20. The tumour is oval in shape, about
the size of the foetal head. It has a well-formed capsule of connect-
ive or fibrous tissue, and was situated quite subcutaneously over the
right scapula,— loose areolar tissue in considerable quantity inter-
vening between the tumour and the infraspinatus and latissimus
dorsi muscles. There was no distinct pedicle, but several large
blood-vessels were found ramifying over the surface of the capsule,
and (with some stronger strands of fibrous tissue) were parti
cularly developed at the posterior inferior aspect of the growth.

On section the tumour has a lobulated appearance ; is moderately
firm in parts, in others is succulent from free infiltration
with a mucilaginous, sticky material ; and at one end there
is a portion which presents unusual softness, and a pinkish
or creamy-yellow colour, due evidently to haemorrhagic and
mucoid changes. This portion can be almost “shelled out” of
the rest of the tumour.

Under the microscope, the structure is seen to consist of closely packed white
fibrous tissue, very densely infiltrated with minute fatty granules and
globules, and also with glistening mucoid material. The softened portion
above described shows an abundance of small round and spindle cells
and yellowish pigmented corpuscles (blood cells), also much free fat and
mucus. This portion of the tumour, therefore, is of suspicious structure,
though the greater bulk of the growth appears to be fibroid.

Presented by Professor K. McLeod.

SERIES XVII.]

KECU11RENT SAECOMA.

641

51. This preparation illustrates the recurrence of the tumour above

described, — removed seven and a half months after the first oper-
ation. It bad reappeared near, and partially involved, the cica-
trix left by the latter.

It is seen to consist chiefly of two rounded masses, separated from
each other by a considerable thickness of normal loose connect-
ive tissue. The larger of the two is hollowed out at its centre
from mucoid softening. Both growths implicate, to but slight
extent, the superjacent skin.

Examined microscopically, the structure is much the same as that of the primary
growth, only that the fibrous tissue is less firm — more frayed out, and
freely infiltrated with glistening mucoid material. With this kind of
myxomatous tissue are intermingled numbers of very small, delicate,
spindle cells, having distinct rounded nuclei, and also small round cells —
the size of white blood-corpuscles. The tumour has therefore a more
pronounced sarcomatous structure, and it is interesting to note how the
the firm fibrous tissue of the primary growth has degenerated, as it were,
into mucoid tissue in the recurrent tumour. There is, however, still
no marked infiltration of the surrounding structures, — the skin being only
involved along the cicatricial line of the first operation, and the two
main lobules of which this growth is composed are well defined and
circumscribed.

52. T umour removed from the back of a native male patient, aged 45.

“ It is of 25 years’ growth, and xvas situated at the lower part of the dorsal
region, exactly in the median line, covering the spinous processes of the
last five dorsal vertebrae, and beneath the skin. The latter was thickened
and tuberculated. The tumour was movable, and had a tense elastic
feel. The cervical aud inguinal glands of the left side were much enlarged.
There was no history of a fall or of any local injury.”

The tumour is kidney-shaped ; has a distinct, but not easily separable,
capsule of connective tissue. On section, is somewhat soft and
succulent, but not friable. About one-half has (in the fresh
state) a pearly- white glistening appearance, the rest is dull-red,
and exhibits the open mouths of groups of dilated capillary
vessels. The paler portion consists of very delicate nucleated
connective tissue, and is sparingly vascular. The reddish
stained portion is made up of round and fusiform cells of small
size with solitary large nuclei, lying very close together, or
separated by imperfectly fibrillated tissue. This portion is
highly vascular — the blood vessels are large, dilated, varicose,
and in parts so closely grouped that a kind of cavernous arrange-
ment or structure is displayed. The tumour is, therefore, a mixed
sarcoma or fibrosarcoma. The change from a comparatively
simple (fibrillated) to an almost purely cellular (embryonic) tissue
is marked and abrupt. Here and there mucoid degeneration of
the cell elements is also observed, and the presence of small
sanguineous cysts.

Presented by Professor K. McLeod.

53 Preparation showing the recurrence of the growth above described
after an interval of about ten months. Itispartly nodular, partly
infiltrative, and involves the cicatrix left by the first operation.

RECURRENT SARCOMA.

[SEBIES XVII.

642

The largest nodule is the size of a walnut, and consists,
undei the microscope, of spindle cells closely grouped together,
or in parts forming an immature fibrillated tissue which is abun-
dantly nucleated. The vascular supply is very considerable.
The structure is strictly sarcomatous.'*

54. “ A fibrous tumour removed from a patient in the Medical

College Hospital. It is about the size of a small orange. Its
outer layer is made up of dense, opaque, unyielding fibrous
texture, and measures three-quarters of an inch in thickness.
I lie interior of the growth consists of coarser fibrous tissue.”
(Ewart).

The section made through the. growth displays very characteristically its dense
fibrous structure, which is confirmed on microscopical examination, — the
tumour substance consisting entirely of very closely interlacing strands of
connective or white fibrous tissue. (J. F. P. McC.)

Presented by Dr. J. Fayrer.

55. A large fibroma showing central softening and the formation,

in consequence, of pseudo-cysts. The main growth is very firm’
and consists of closely-woven nucleated connective tissue, the
filaments of which interlace in all directions in an irregular
manner. There is a well-defined fibrous capsule, which has been
peeled off portions of the tumour, but in other parts remains
attached and very distinct. No history.

56. A huge fibroma of the lower jaw, with four teeth imbedded in

it. The tumour is surrounded by a thin osseous shell— the
expanded outer lamina of the jaw. On section, the tumour
tissue is very firm and condensed— distinctly fibroid-looking, and
microscopically, is found to consist of very fine white fibrous
(or connective ) tissue, closely interlaced, and throughout very
firm and rigid. Here and there a small nodule of cartilage is
encountered, but the main bulk of the growth is purely fibroid.

• The subsequent history of this case is interesting, and seems worthy of record The
last operation was performed on the 8th July 1881, but the wound granulated' very
slowly, and the patient suffered intensely from shooting lancinating pains in the lower
limbs. This culminated in complete paraplegia on the 2nd of October. Bed-sores now formed
over the sacrum, the wound became sloughy, the patient extremely depressed, occasionally
delirious : intractable diarrhoea set in, and he died thus exhausted on the 7th October. After
death it was found that a recurrent sarcomatous nodule in the wound had made its way into
the spine, the eleventh dorsal vertebra being almost entirely absorbed, and the cord and mem-
branes compressed and much softened at this spot. The latter were, however, unbroken. The
softening extended to the cauda equina. The upper half of the twelfth dorsal vertebra was con-
verted into firm, but lardaeeous-looking material, having a glistening, pale-yellowish appear-
ance. The first lumbar vertebra was healthy, the second completely transformed into the same
substance as above noted. The third lumbar was again free, but the fourth and fifth were mor-
bidly affected, and much flattened from above downwards. None of the intervertebral cartilages
were involved. The changes referred to were very peculiar. No reproduction of specific, i.e.,
sarcomatous structure, was discovered (on microscopical examination), except in the soft
parts in the immediate vicinity of the destroyed vertebra (eleventh dorsal). The glistening
lardaceous material into which the bodies of the other vertebrae had been partially or
wholly converted was purely fibroid, i.e., consisted of closely-meshed white fibrous tissue,
firm and tough, swelling up on the addition of acetic acid, and then displaying numerous
small nuclei, but no proper cell elements, and nothing approaching to sarcomatous transform-
ation. The change seems to consist essentially of a dissolving out or deprivation of the
mineral or earthy matter of the bone, with its reversion to a primaitive fibroid tissue, either
wholly or in part decalcified bone, nothing else abnormal is discoverable. In both lungs
and in the liver small ill-defined sarcomatous nodules were found, but these also exhibited
an unusually firm consistency and fibroid structure ; the cell elements — round and spindle-
shaped-being but few in number and of small size. (J. F. P. McC.)

SERI US XVII.]

FIBROMA.

643

57. Another very firm and dense fibroma of the lower jaw. The

tumour is the size of a large orange. Six teeth can be seen
imbedded at one portion. It has a well-defined, slightly lobula-
ted outline, and a capsular investment partly fibrous partly
bony. Like the preceding tumour, it seems to have developed
from the interior of the jaw, expanding the bone around it; and
its microscopic structure is also almost identical — consisting of
fine, closely interlacing filaments of white fibrous tissue, with
here and there a small nodule of cartilage.

58. A very firm hard fibroma, involving the right-half of the lower
jaw. Several teeth are seen still imbedded in the growth, but
much displaced. The outline is lobulated. The cut surface
smooth and almost homogeneous. Very closely-woven and con-
densed white fibrous tissue composes the structure of the growth,
as seen under the microscope.

Presented by Professor S. B. Partridge.

59. A very firm, whitish, somewhat reniform tumour, with a single

incisor tooth projecting from one portion of it, and said to be “ a
scirrhus tumour removed from the upper jaw.” (Ewart.) On
section it is remarkably dense and fibrous-looking, the fibrillas
having a somewhat concentric arrangement. The outline of the
tumour is lobulated ; it cuts like cartilage, and is also gritty —
as if particles of bone were imbedded in the tumour tissue. This
is confirmed on microscopic examination, — the structure consist-
ing entirely of white fibrous tissue, with here and there minute
particles of imperfectly formed bone. There is no abnormal cell
growth, no cancerous development ; the tumour is a simple
fibroma.

60. Amputation of the right hand (with the exception of the
thumb and index finger) for a tumour situated on the posterior
aspect of the metacarpal bones of the ring and little fingers,
and ulcerating through the skin.

The growth is oval in shape ; slightly nodulated in outline ; the size
of a large orange. It is very firm and fibrous-looking on
section, and has originated apparently from the sheaths of the
extensor tendons on the back of the wrist and hand. The struc-
ture, microscopically, is purely fibroid — consisting of closely
intersecting bands of well-formed fibrous or connective tissue,
interspersed with minute nuclei. No other new or morbid
growth.

The tumour is described as a “ fungus haematodes.” (Ewart.) Though
the skin over it is ulcerated, and a sinus an inch in length leads
into the substance of the growth, there is nothing malignant in
its general structure.

The subject was a native male, aged 42. “ A small hard incompressible tumour, the

size ot a filbert, had been excised from the region of the metacarpal bone
of the nng finger, three years before. The constitution of the patient
suffered greatly from the unhealthy, ichorous, and sanguineous discharge.”
lhe ultimate result of the operation is not recorded.

61. A fibroma removed from the inside of the mouth. The surface is
smooth ; slightly lobulated; the consistency very firm and dense ;

644

FIBROMA.

[series XVII.

and the cut surface has a distinctly fibrous appearance. Under
the microscope, consists of wavy white fibrous tissue, in parts
very closely interwoven, in others infiltrated with small nuclei,
and exhibiting also a few elastic filaments.

62. A very firm lobulated fibroid growth (epulis), with a portion

of the alveolar border of the lower jaw, and a couple of imbed-
ded incisor teeth.

“ The growth was of seven years’ standing, and occurred in a middle-
aged coolie. It commenced with a small excrescence on the gum,
and gradually increased until it perforated the muscles and skin
of the cheek, where a large ulcerated surface was exhibited.
Part of the ascending ramus of the jaw was expanded and
hollowed out. The inferior dental artery supplying the growth
was much larger than natural. The operation for extirpation
was completely successful. The wound healed up rapidly, and left
very little deformity.” Microscopically, the tumour is com-
posed of white fibrous tissue, some of it well developed, but
much still in a transitional condition, soft, and abundantly
nucleated. It contains several large blood-vessels.

Presented by Dr, Simpson.

63. “ Fibrous tumour developed within the ramus of the lower jaw,

which is dilated into a bony shell, completely enclosing it. At
one point, where a glass rod has been inserted, the line of demar-
cation between the tumour and its bony shell may readily be
recognized. The growth shows nothing,— under the micros-
cope,— but dense white fibrous tissue.” (Colles.)

Presented by Dr. Herbert Baillie.

64. “ Fibrous tumour of the dura mater. It pressed on the upper
surface of the left cerebral hemisphere, and depressed the brain
below into a deep cup. From a subject in the dissecting room.”
(Colles).

The tumour, which is firmly fixed to the inner surface of the
dura mater, is as large as a nutmeg, consists of fine fibrous
tissue, with a considerable admixture of elastic filaments ;
and is interspersed with numerous opaque cretaceous granules
and corpora amylacea.

65. Two small fibroid growths removed for the second time from the

lobules of both ears, — similar growths having been excised one year
previously. From a native boy, aged 11 years. The structure,
under the microscope, consists of very delicate nucleated connect-
ive tissue.

Presented by Professor J. Fayrer.

66. A small dumb-bell shaped fibrous tumour “ removed from the ear

of a boy aged about 12. It had been growing for the last five
years, being the result of piercing the ear,”— (the lobule, pro-
bably, for an ear-ring). “ On microscopic examination it consisted
of fibres, a few nuclei, and granular matter.” (Ewart.)

67. A firm, fibroid tumour, removed with a portion of the left upper

jaw “from a native lad, about 25 years of age.” Two
incisor teeth are imbedded in the growth anteriorly, and a molar
lies partly detached with a piece of the alveolus at the posterior

SEEIES XVII.]

FIBROMA.

545

aspect of the tumour. Under the microscope, the structure
consists of fine, closely- woven, nucleated, fibrous tissue, which in
several places is developing' into bone — islets of imperfectly
formed osseous tissue being found abundantly distributed in
every section made for examination.

Presented by Professor J. Fayrer.

68. “ A fibrous tumour removed from the mouth of a woman, aged

55. It began seven years ago as a small nodule springing from
the alveolar process of the right upper jaw, and gradually
increased, until in five years it almost completely filled the
mouth, and greatly distended the cheek. For the last two
years it had enlarged externally only; — amass the size of a hen’s
egg having protruded from the mouth.” *##*##*
“ For these two years she has been unable to take any solid food.
The teeth of the lower jaw were much displaced, and the alveolar
process of the superior maxilla almost entirely absorbed.”
***** * “ The tumour has been painless throughout,

until a fortnight ago, when inflammatory action began in the
external lobe, but it has caused toothache and earache at times
from pressure.”

Examined microscopically, the growth consists of dense, closely interlacing bands
of white fibrous tissue, very firm and rigid, sparingly nucleated, and
sparingly supplied with blood-vessels. Towards the surface it is papillated,
and invested by the common mucous membrane of the mouth; — a simple
fibroma.

Presented by Dr. It. Harvey, Presidency Surgeon, Bhurtpore.

69. “ Large fibrous tumour involving the right half of the lower jaw.

It appears to have sprung originally from the periosteum, but
much of what forms the tumour is hypertrophied gum. The
lower portion is covered with a bony shell. The jaw was
excised from the left second molar to the angle, and the right
ramus then dissected out. (It has now been re-attached to the
rest of the specimen). The patient, a Musalman, aged 25,
made a good recovery. The tumour had been growing for five
3rears. rIhe microscope shows nothing but white fibrous tissue.”
(Colles.) See also Indian Medical Gazette , July 18GG,page 182.

Presented by Dr. W. B. Beatson, Mitford Hospital, Dacca.

70. The left superior maxilla removed on account of a fibroid
tumour, which had developed, apparently, in the antrum. “ It
commenced about two years ago, and was progressing slowly,
but about four months ago a portion of the growth which
projected from the nose was sliced off by a native practitioner,
and an escharotic applied. Since then the tumour has rapidly
increased, and sent prolongations in various directions — upwards
into the orbit, forwards into the left nostril, backwards through
the posterior nares into the pharynx— bulging down the hard
palate, and thus producing great deformity.”

Under the microscope,, the growth is found to be purely fibroid,— consists of white
fibrous tissue, m parts freely nucleated, and some elastic filaments, but no
structure'10 ^ DeW gr°Wtl1’ ami notlling approaching to malignant

Presented by Dr. W. E. Allen.

FIBBOMA. [8EBIE8 xvn.

Fibroma of the upper jaw. “The growth filled the mouth,
projecting between the teeth. It had originally sprung after the
removal of a tooth —probably the right upper canine — from the
alveolar process. Age of the growth upwards of two years.
Was removed by an incision through the upper lip and into the
right nostril ; this afforded space for cutting pliers, and the
resection of the portion of the alveolar process to which the
mass was attached.”

tumour is about the size of a small orange ; broadly and irregularly
lobulated ; surface smooth and generally rounded. Two° teeth
(one a bicuspid the other a molar) are half imbedded in the
growth, and a portion of the gum and alveolus of the jaw
also remain, the latter being almost completely surrounded by
the tumour. The growth presents a dense-white, fibrous
appearance, the arrangement of the fibres being irregular,
interlacing with each other in various directions, and most closely
at the periphery,— the most compact and firm part. The fibrillaj
are glistening-white and delicate.

Under the microscope, the tumour presents (in thin sections) numerous delicate
intersecting1 bands of white fibrous or connective tissue, intermingled with
which are nuclei, and caudate and stellate connective-tissue cells ; here and
there a small piece of cartilage and bone. No myeloid cells exist. The
growth is therefore an almost purely fibrous tumour , and constitutes a
variety (the non-myeloid) of epulis.

Presented by Dr. James K. Jackson, Civil Surgeon, Mynpoorie.

72. A fibroid tumour, weighing 3ibs. 14 ozs., removed from the left
thigh of a native boy, aged about 16. It was said to be of 12
or 13 years’ growth. The tumour is ovoid in shape, has a
broadly lobulated outline, and firm but elastic consistency. It
is invested by a thick fibrous capsule, upon which blood-vessels
ramify, — some of very large size. On section, a dull-white, more
or less homogeneous appearance is presented, and the lobulated
character of the growth well displayed. The central portions
have undergone softening and purification. Numbers of
enlarged lymphatic glands were found filling Scarpa’s triangle,
but not directly associated or connected with the tumour.
These were excised at the same operation, and are preserved
with the principal growth.

Under the microscope, the central portions of the tumour present nothing but a
granular, amorphous, fatty debris, and a few small shrivelled cells; towards
' the periphery the growth has a very finely fibrillated structure, — the
fibrillge interwoven very closely, and exhibiting numerous minute nuclei
on the addition of acetic acid. The vascular supply is not abundant, and
is chiefly confined to the capsule.

The lymph-glands are dense and firm ; show great overgrowth of their
fibrous dissepiments (parenchyma), with shrinking and atrophy of the
lymph cells, and considerable caseation towards their central portions.

The tumour seems to be a. fibroma of the firmer or denser (homogeneous)
variety.

Presented by Professor W. J. Palmer.

5 16

71.

SEBIES XVII.]

FIBROMA.

5-17

73. Tumour excised from the abdominal wall of a native male, aged

40. The growth was of eight years’ duration. A portion of
the skin has been removed with the tumour, which is ovoid in
shape ; the size of a large orange ; slightly lobulated ; smooth
and homogeneous on section ; and of a dull- white colour. It has
a delicate but well-formed capsule of connective tissue. Under
the microscope, the growth is found highly cellular, — the cells
small, spindle-shaped or round, but combined to form fasciculi
of various sizes, which interdigitate with each other, or have a
more distinctly concentric arrangement, i.e., immature fibrous
tissue. The tumour is a fibroma of the cellular variety, or a
so-called fibro-cellular growth.

Presented bij Professor Gayer.

74. F ibroma of the lower jaw ; said to be of about three years’ growth.

“It first appeared as a small nut-like swelling on the outer aspect
of the gum, opposite the left lower molar teeth. For twelve
months increased very little in size, but during the last two
years has made more rapid progress.” From Bhipro, a Hindu
aged 20.

The growth involves the whole of the left half of the jaw, and extends
a little beyond the symphysis. The bone has been divided half
an inch beyond the latter, and disarticulated at the left condyle.
The tumour is massive, very solid to the feel, convex, rounded,
and for the most part smooth externally, and flattened on its’
inner aspect, thus closely following the conformation of the jaw.
On longitudinal section the structure is found firm but
elastic, more or less homogeneous, and of a creamy-yellow
colour. The bone has been enormously expanded by the tumour,
which haS evidently originated in its interior. Only a narrow
rim or shell of osseous tissue now surrounds the growth on its
inferior and lateral aspects, while superiorly, the alveolar margin
has been completely absorbed, — the tumour here projecting into
the mouth, and being covered by thickened mucous membrane.

On microscopic examination, the structure consists of nucleated white fibrous
tissue, not perfectly developed, i.e., not forming filamentous bands or
bundles, but a kind of intricate mesh or network. Here and there a few
cartilage corpuscles are seen scattered, and small islets of bone also bur the
main bulk of the growth is purely fibrous, and the tumour is a true
jibroma of the jaw.

Presented by Professor S. B. Partridge.

75. Fibrous tumour of the lower jaw excised with a portion of the

bone. It is said to be. a growth of two years’ duration, and
first appeared as a pimple near the right angle of the lower
maxilla. Has increased slowly and without pain.” The tumour
is ovoid in shape, and has a thick capsule of connective tissue
apparently continuous with the original periosteum of the law’
from which the growth has evidently developed. The portion
of this bone excised with the tumour consists of the right half
of the horizontal ramus, from the symphysis to the angle The
growth surrounds the bone,— with the exception of the alveolar
maigin and teeth, hut has developed chiefly outwards and down-

548

FIBROMA.

[series XVII.

wards. On section, it is very firm and dense, has a pearly-white,
lustrous appearance (in the fresh state), and is distinctly fibroid
looking. This is confirmed on microscopical examination, — •
the tumour structure consisting of white fibrous tissue forming
intricate interlacements, and plentifully supplied with rounded
or angular nuclei — a simple fibroma.

Presented by Professor K. McLeod.

76. Tumour removed from the left buttock of an adult European
(male). “ Its duration is said to have been about six years. It
grew over the soft parts covering the left tuber ischii, and did
not infiltrate any of the neighbouring or subjacent tissues. The
skin over it was freely movable. The patient has another
tumour of the same size, situated at an almost exactly similar
position on the right buttock.” The tumour consists of two
separate and distinct nodules,— one rather larger than a hen’s
egg, the other the size of a nutmeg. They are both encapsuled,
and connected together by a little loose fibrous tissue. The
smaller growth is exceedingly hard and dense — cutting like
cartilage. The larger one is also very firm and resistant at the
periphery, softer and more succulent towards the centre. Their
structure is identical, consisting (under the microscope) of fibro-
cellular tissue, i.e., white fibrous tissue abundantly nucleated,
and forming very closely- woven intersecting bands. With this
there is an unusual amount of elastic tissue, and, where the
larger growth shows comparative softness of texture, much mucoid
metamorphosis of its constituent fibrillse. Essentially, the
tumour is a subcutaneous fibroma .

Presented by Professor K. McLeod. #

77. “ Painful subcutaneous tumour or tubercle ” of seven years’

duration ; removed from the inside of the right arm of a Hindu,
aged 50. It was “ soft and fluctuating to the feel, very tender,
and subject to periodic exacerbations of pain.”

Examined microscopically, the little growth consists, principally, of
white fibrous tissue forming closely-packed filaments, with here
and there elastic fibres, and, in parts, delicate nerve fibrils the
implication of which may perhaps account for the painful
character of the tumour.

Presented by Assistant Surgeon Odoy Chand Dutt, Pooree,

78. A small parotid tumour, from a native male patient, aged about

25. It originated as a hard nodule in the right parotid
region, and is stated to be of two years’ standing. The
growth is lobulated, ovoid, the size of a hen’s egg. It possesses
a distinct capsule, over which minute vessels are found rami-
fying, and passing inwards into the substance of the tumour
upon fibrous dissepiments which intersect it in various directions.
The structure (under the microscope) is fibro-adipose, — both
white and elastic fibro-cellular tissue and much fat constituting
the whole mass of the growth. No cartilage or gland cells are
visible,— the tumour is a fibro-lipoma.

Presented by Professor S. B. Partridge.

SERIES XVII.]

CYSTIC FIBROMA.

649

79. “A congenital tumour, removed from the right foot of a native
male patient aged 40. It is oval in shape, about 3V x 2'' x 1|".
Has no distinct capsule. On section, is very firm and dense.
Has an opaque-white colour, and fibroid appearance. The
fibrous fasciculi intersect each other in various directions, and
in parts form bundles of considerable size. Under the micros-
cope, the structure is seen to consist of highly nucleated
fibrous or connective tissue, intermingled here and there with
smooth muscular tissue. Blood-vessels of considerable size
are also found permeating the substance of the growth freely.
The little tumour is a fibro-myoma.

Presented by Professor S. B. Partridge,

80. Fibro-cystic tumour of the lower jaw. It is said to have been
growing for three and a half j^ears, and the patient, a Hindu,
aged 40, associated its development with an injury to the part,
viz., a kick from a horse.

Almost the whole of the lower maxilla appears to have become involved
in the growth, which seems to have originated within the
bone, and to have expanded and hollowed out its structure. It
forms thus a broadly lobulated mass of crescentic shape, following
closely the outline of the jaw. Covering the upper surface is
the greatly thickened mucous membrane of the mouth, elsewhere
the thinned and stretched periosteum of the bone. Even from
the exterior the tumour looks cystic, and on palpation crackling
and fluctuation are elicited over certain parts. The cystic change
is, however, best observed in the longitudinal section of the
growth which has been made : — the whole mass consisting of
larger and smaller cavities (varying in size from a pea
to a walnut), with portions of semi-solid tissue between
them. The cysts contain fluid which is thin, dark-red, and
truly sanguineous, or yellowish-brown and oily-looking. The
partitions between them are composed chiefly of osseous tissue,
but hero and there combined with softer, fibrous-looking or
even quite pulpy material. Such softer portions of the growth,
examined microscopically, consist principally of broad bands of
white fibrous tissue, closely and intimately interlacing with
each other. In parts this tissue is replaced by a more fibro-
cellular growth, or even by small portions of newly-formed
bone and cartilage. The greater portion, however, of this softer
tissue is decidedly fibrous, and the growth may therefore be
regarded as a true fibro-cystic tumour of the jaw.

Tlie patient died on the table a few minutes after the operation (removal of the
whole jaw with the tumour) had been completed. Artificial respiration
and all other means were attempted, but failed ; the breathing had somewhat
suddenly ceased, and could not be re-established. On post-mortem exanrn-
ation (about seven hours after death), the trachea close to its bifurcation
the bronchi, and almost all their branches, were found filled with partly
coagulated, partly frothy fluid blood. The posterior halves of both luim-s
were collapsed and destitute of air, the anterior portions emphysematous.
Ine right side of the heart was loaded with very dark fluid blood the left
empty. All the abdominal organs showed marked venous congestion and
so did the membranes of the brain There was no blood in the stomach.

650 "1 MYXOMA. [series xvii.

7 ‘'^The cause of death was therefore, evidently, asphyxia from the trickling

A !'• downwards into the air passages of blood from the mouth during the
operation, until the bronchi became so blocked that respiration could
no longer be carried on. The heart looked healthy, but, under the microscope,
showed marked fatty metamorphosis of the muscular tissue (of the left
ventricle in particular).

Presented by Professor S. B. Partridge.

81. A tumour removed from the right great toe of a native male

patient ; “ said to be a growth of about seven years. The
inguinal glands were slightly indurated.”

The tumour is as large as an orange. It involves the lower third of
the metacarpal bone and both phalanges of the great toe, —
developing apparently from the periosteum investing these bones.
It forms a rounded, more or less smooth swelling over the dorsal
and inner aspects of the toe. The epidermis is slightly thickened,
the cutis vera considerably so. There is no distinct capsule.
On section, the growth is soft and succulent, in parts opalescent
and jelly-like, in others curdy and opaque. The osseous tissue
of both phalanges is carious and very soft, but the bone is not
enlarged or expanded, and seems merely to have suffered from
the pressure of the new growth — (affecting its nutrition), i.e.,
shows no infiltration, &c.

Ou microscopic examination, the structure of the tumour consists of a delicate
fibrous reticulum, with large, mostly rounded meshes, filled with glistening
mucoid material, amidst which numerous angular, elliptical, and stellate
cells can be recognised, many of them grouped together by means of
long-tailed anastomosing processes. These are nucleated and almost
all Infiltrated with mucoid. In other parts, the connective tissue frame-
work is dotted over with only small round cells and nuclei ; — is soft, and
evidently proliferating. A good deal of elastic tissue is also distributed
throughout the growth. The tumour is a true myxoma,.

Presented by Professor S. B. Partridge.

82. The anterior portion of the skull showing a polypoid, tumour

involving both nares, and which projected backwards into the
pharynx. It has also perforated the cribriform plate of the
ethmoid, and thus entered the cranium. Acute meningitis
with the formation of a small circumscribed abscess in the right
anterior lobe of the brain was the result, and led to a fatal issue.
The patient was a native male, aged 25. He had been operated
upon for a nasal polypus three months previously, the growth
being removed by evulsion. After this he suffered from repeated
epistaxis, and the polypus began to grow again. Was kept
under observation, and the haemorrhage from the nostril con-
trolled by plugging. Head symptoms soon developed he
became restless, convulsed, and at last insensible, and thus died.
The exact condition of parts was only discovered post mortem,
and is exhibited in this preparation.

The portion of the growth in the nares and pharynx (really the pedi-
cle of the polypus removed during life) is about the size of a
walnut; that which has penetrated the skull is a little larger.
Both portions are very soft, and of a greyish-pink colour. Their
structure is identical consists of very delicate intersecting

sebies xvii.] MYXOMA. \. .551

x ‘o i ' •

■*V * / '

fibrillse of soft gelatinous-looking connective tissue (from free
infiltration with mucoid globules). The cell elements are few
in number, irregularly distributed, stellate or caudate, nucleated,
and also mucoid. The growth is, therefore, a myxoma (or libro -
myxoma), and although histologically an innocent tumour, has
proved fatal from the progressive implication of important
structures.

83. A small polypus, removed by evulsion from the posterior nares.

The growth is pear-shaped, but flattened. The pedicle is
rounded and firm. The surface smooth, but blotched. On
section, the structure is fibroid — fine white lines or streaks inter-
secting the basis-substance in all directions. Thin sections
placed in water swell up, and become very soft and gelatinous.
Under the microscope, a flickering and soft (evidently mucoid)
basis-substance is seen, plentifully infiltrated with cell forms,
which are mostly angular or stellate and nucleated. Among
them are rounded, smaller corpuscles — obviously blood-cells, both
white and red. The basis-substance is not homogeneous ; in parts
it is fibrillated, and forms spaces or alveoli of rounded or oval
outline. These alveoli are filled with mucoid material and cells
of the same kind as just described. Blood-vessels are plentiful,
and here and there small sanguineous cysts are also found. The
entire structure is purely myxomatous.

From a native male out-patient, aged 22.

Presented by Dr. E. Lawrie.

84. Fibro-myxoma from the parotid region — a growth of “ upwards
of seven years.”

The tumour is ovoid, three inches in length, and about an inch and
a half in breadth or thickness. It has a distinct but delicate
capsule of condensed connective tissue. Blood-vessels very few.
Surface much lobulated.

The structure, under the microscope, is seen to consist of fine fibrous
tissue, the fasciculi of which are closely interlaced, and show
much fatty metamorphosis. This constitutes the bulk of the
tumour ; but, in parts, large stellate cells are found, having
single or double nuclei, and freely infiltrated with mucoid
material. Here and there, also, a few cartilage corpuscles are
observed. The connective tissue of the growth is throughout
abundantly nucleated.

85. A small fibroid growth from the inner surface of the dura mater.

It is attached to the right side of the falx cerebelli. From a
native female, aged 50, who died of pyaemia.

' The growth is about the size of a nutmeg ; slightly oval ; surface
smooth, and covered by a layer of flattened epithelial cells, resting
on a delicate but distinct basement membrane, which is plenti-
fully supplied with small capillary blood-vessels. The tumour
is moderately firm in consistency, and of a glistening- white
colour on section.

•On microscopic examination, its structure consists of soft broad bands of white
fibrous tissue, (much of it in the form of undeveloped or imperfectly

oo2

ELEPHANTOID TUMOUES.

[series XVII.

developed connective tissue), numerous nuclei, and stellate cells having
mucoid contents. The little growth is therefore a Jibro-myxoma.

86. Two enormous labial tumours and the hypertrophied clitoris,

removed by one operation, from a Mahomedan female, aged
about 25.

“ The patient has been subject to malarious fever from time to time.
She has no children, nor has had any miscarriages. Menstru-
ation regular. The morbid growth is said to be of about a
year’s duration. ” The preparation exhibits two ovoid growths,
each as large as the adult head, — consisting of the hypertrophic
labia, with an intermediate irregularly lobulated mass — the
“ elephantoid ” clitoris and prepuce.

One of the labia has been bisected to show its structure. This is seen
to consist of a highly gelatinous or mucoid tissue, i.e., loose
connective tissue, freely infiltrated with flickering, opalescent,
mucoid material. The peripheral portion of the growth, to the
depth of about half an inch, is firm and fibrous-looking; it has
a dead-white appearance, and cuts like ligamentous tissue. The
structure of the other labium and of the clitoris is, in all essential
particulars, the same.

Microscopically examined, the epidermis is found very little hypertrophied; the
dermis or cutis vera is much increased — particularly the rete mueosum and
its dark granular pigment. But the chief change is in the subcutaneous
cellular tissue. The superficial layers exhibit a dense fibro-cel hilar struc-
ture— broad bands of nucleated white fibrous tissue intersecting each other
in an irregular manner in all directions. The blood-vessels are of large
calibre and have thickened walls ; and large, thin-walled channels lined by
flat epithelium (probably dilated lymphatics) are seen following, more or less
closely, the distribution of the enlarged blood-vessels. At certain intervals
along these (lymphatics) there are accumulations (depots) of cells like white
blood-cells (lymph corpuscles), which seem to have escaped by rupture
or otherwise, and show a tendency, at the margins of the depots, to a
linear dispersion or disposition (parallel to the surface of the skin) in
the interstices of the fibrous net-work.

In the deeper strata, much elastic tissue — with long curling or wavy filaments, is
seen, and the mucoid infiltration is large. Numbers of round, angular,
and stellate corpuscles, with single nuclei and caudate processes, are found
here, and the blood-vessels are also abundant. Not much adipose tissue
is found, although, to the naked eye, this also appears to be in excess.

The growths are, therefore, fibro -myxomatous, and in other respects also correspond
to the well-known characters of “ elephantoid tumours.”

Presented by Professor T. E. Charles.

87. A “scrotal tumour” removed from a Hindu aged 40. The

growth is said to have been of one year’s duration. It weighs
about 13 ounces.

This is a characteristic specimen of noevoid elephantiasis, and exhibits
all the specific peculiarities of such growths.

On microscopic examination, the following abnormal changes are observ-
ed in the cutaneous and subcutaneous structures : — (a)
epidermis , — greatly hypertrophied ; the epithelial proliferation
abundant but irregular, and forming more or less papillary or
tuberous excrescences, some very soft and spongy, others bard
and wart-like, (b) Rete mueosum , — well formed, very dark

SERI E8 XVII.]

NCE VO ID ELEPHANTIASIS.

553

filled with much black granular pigment, particles of which
are to be traced into the cutis vera at the bases of the papillae,
(e) Cutis vera , — very greatly hypertrophied, — the papillae large
and broad. Towards their bases, loculi or spaces are found, oval
or rounded in shape, lined by a delicate and imperfect layer of
pavement or flat epithelium (rendered very visible after staining
of sections with nitrate of silver). These spaces or ampullae
appear to be lymphatic enlargements, although it is very difficult
to trace their direct origin from, or communication with, vessels
of this system. (<1) Subcutaneous tissue, — the normal fibro-
elastic tissue is highly developed, forming coarser and finer
strands, which decussate irregularly with each other, and con-
stitute a dense reticulated structure, in the meshes of which a
very abundant nuclear growth is observed the nuclei small,
round, and nucleolated, some as large as, others smaller than,
leucocytes or blood-corpuscles. Very little adipose tissue is
found, — it is, in fact, remarkably scanty. As the deeper strata
are reached, the smooth muscular tissue of the dartos comes
into view ; — the fibres are highly developed, and intersect each
other irregularly. The subcutaneous blood-vessels are also
abnormally large, and in parts dilated ; their walls (particularly
as regards the arteries) thickened. The remains of hair-bulbs
and stfeat glands — few, and the latter distinguished with some
difficulty.

The great and leading characteristics of the growth are (1) the excessive
development of the cutis vera, subcutaneous fibro-elastic tissue,
and dartos ; (2) the diffuse infiltration of all these structures
by a small round-celled or nuclear growth, reaching upwards
into the papillae, and downwards into the deepest layers of the
subcutaneous tissues ; and (3) the ampulliform dilatation of
the lymph-canals. The hypertrophy of the epidermal epithe-
lium is inferior to that of the dermis or cutis vera.

88. “ Lymph-scrotum ” or ncevoid elephantiasis of the scrotum.

From a native male, aged 30. The growth was of two years’
duration. The inguinal glands were enlarged and indurated.
The skin of the perinseum and that around the anus was also
thickened and diseased, and was removed with the rest of the
tumour.

This is a very well-marked example of the so-called noevoid variety of
elephantiasis. It affects both the prepuce and the scrotum.
These parts, especially the* latter, are covered with warty and
bulbar, soft outgrowths of the skin, which vary in size from a
swan-shot to a hazelnut, and are separated by narrow and deep
fissures, in which is collected brownish sebaceous material.
Several of these outgrowths discharged, during life, a thin
sanious or lymphoid fluid, exhibiting, under the microscope,
blood-cells, lymph-corpuscles, and filarise (F. sanguinis hominis).
The blood of the patient (also examined) contained similar
filarise. Others of the outgrowths are solid, but juicy and
succulent.

LIPOMA:

554

[SEBIES XVII.

Thin sections from various parts of the growth when placed in water
swell up and become pellucid.

Examined microscopically, the epidermal layer is found greatly exaggerated, and
in parts almost warty. Thereto mucosum is normal; the pigment dark
and granular, but not excessive. The cutis vera is chiefly affected. Its
papillary and superficial strata are infiltrated, in great abundance, with
small round cells and nuclei ; show larger and smaller lymph-spaces ;
dilated capillaries, forming— just beneath the papillary layer— a plexiform
arrangement, quite ncevoid in character on cross section. Deeper down,
the smooth muscular tissue of the dartos, the sudoriferous and sebaceous
glands come into view — all much hypertrophied; and the subcutaneous
fibro-elastic tissue is throughout hyperplastic. There is a remarkable
absence of fat.

89. A very typical, deeply lobulated, fatty tumour (lipoma), removed

from the anterior wall of the abdomen. It was situated just
beneath the skin, measures six inches in length by four inches
at . the broadest portion, and consists of two principal lobes
united by a thick isthmus. Each of the lobes is further sub-
divided into lobules by deep fissures, and the whole growth is
invested by a delicate capsule of connective tissue.

90. “ A fatty tumour removed from the region of the deltoid. The
smooth uniformity ,of the section — only interrupted by a few
scattered blood-vessels — is well illustrated. Microscopic examin-
ation shows fat globules distinctly.” (Ewart.)

Presented by Dr. Herbert Baillie.

91. Fatty tumour or lipoma — the size of a pomegranate, and with a

short thick pedicle. The skin over the growth is remarkably
tense and smooth, and the consistency of the tumour so soft
that it was supposed to be a cyst. It is, however, throughout
solid, and purely fatty.— Eemoved from the left groin of a native
female aged 45.

Presented by Professor S. B. Partridge.

92. “ A fatty tumour, weighing twenty-four ounces, removed from

the left thigh of a native male aged GO.” The remarkably
lobulated character of the majority of such growths (lip-
omata) is well illustrated by this specimen.

Presented by Assistant Surgeon Lukhi Narain Bose.

93. A large fatty tumour “ removed from the left thigh of a prisoner

named Ajoodhee, aged 20 ; of ten years’ growth ; weighing at
time of removal eight pounds.”

The tumour is a magnificent example of a true or pure lipoma ; it is
oval or melon-shaped, circumference 281," long diameter 10,"
short diameter 8." The external surface is smooth ; the capsule
distinct, two to three lines in thickness, and composed of tough
connective or fibro-cellular tissue. The substance of the growth
on section is smooth, homogeneous, and yellow.

Examined microscopically, the tumour is found to consist of pure adipose tissue, i.e.,
large round or oval cells filled with oil, and many of them containing
acicular fat crystals. These are grouped together, in larger and smaller
lobules, by delicate and scanty connective tissue, which, forming tine strands

seeies xvn.] FIBRO-LIPOMA. . 555

or bands throughout the growth, becomes continuous with its capsule at
the periphery.

Presented h/ Dr. J. W. Taylor, Civil Surgeon, Mainpuri, N. W. P.

94. A large fatty tumour (lipoma), removed from the right gluteal
region of a native male patient, aged 32. The growth was of
three and a half years’ duration, and is said to have developed
spontaneously. It weighs 4£ pounds. The tumour has a dis-
tinct capsule of firm fibrous (connective) tissue, and its surface
is highly lobulated.

Presented by Professor S. B. Partridge.

95. Fatty tumour removed from the left groin of a native boy, aged

four years. It was of 18 months’ growth. The tumour is
polypoid or pediculated, and markedly lobulated ; it has a com-
plete well-developed fibrous capsule. Is soft, and of a creamy-
yellow colour on section, and is composed of granules and lobules
of adipose tissue held together by a small amount of nucle-
ated connective tissue, and sparingly supplied with blood-vessels.

Presented by Professor Gayer.

96. “ A fatty tumour, of a pyramidal shape, removed from the breast.

It is about the size of an orange, and entirely made up of small
aggregations” (lobules) “ of fatty substance, each of which is
bounded by delicate areolar tissue. The external aspect of the
growth resembles nothing so much as clusters of grapes when
these are assuming a yellow colour.” (Ewart.)

97. A large, somewhat dumb-bell shaped fibro-lipoma, from the cervical

region. Each division of the growth is as large as one’s fist. The
general outline of the tumour is lobulated. It has a distinct
thick capsule of fibrous tissue. A section through the lower
half of the tumour reveals a broadly reticulated structure of
firm white fibrous tissue, into the meshes of which a large quan-
tity of yellow fat is deposited, — the whole forming a series of lobules
bound together by firm connective tissue, and sparingly supplied
with blood-vessels. “ The swelling had existed for fourteen years,
fmd it was deeply attached to the transverse processes of the
cervical vertebrae. ”

98. A small portion of an enormous fatty tumour removed from the

back and neck of a Mahomedan patient, aged 40. The growth
was of about three years’ duration, and hung, in a semi- pendulous
form — like a huge solid sack, — from the back of the neck and
dorsal portion of the spinal region. The skin was adherent to
the tumour in several places. The structure is seen to be almost
purely fatty. The fat is collected in varying-sized nodules or
lobules, with broad bands or tracts of fibro-elastic tissue
between them. The development of the latter is greater than
in ordinary lipoma, and the growih may therefore be regarded
as a fibro-lipoma. A distinct thick capsule invested the whole
tumour. The patient died from the shock of the operation about
six hours after it was performed. All the organs of the body
were found healthy on post-mortem examination.

(Sec further, “Surgical Post-mortem Records,” vol. I, 1881, pp. 807-8.)

Presented by Professor D. O’C. Raye.

556 ENCHONDROMA. [sebies xvii.

99. A pecliculated Jibro-lipomatous tumour, somewhat flask-shaped,

and rather larger than one’s fist, “ removed from the labium of a
native woman.” The fibrous tissue greatly preponderates.

100. a fibro-lipoma removed from the right shoulder of a native
male patient. The growth is about the size of a cocoanut ; is
markedly lobulated — this being well seen on section, and
closely adherent to the superjacent skin. The structure consists
of large firm masses of adipose tissue, separated by an unusual
and very large amount of nucleated white fibrous tissue, which
renders the whole tumour exceptionally dense and resistant.

Presented by Professor K . McLeod.

101. A small hyaline enchondroma of the last phalanx of the great
toe. The growth has developed in the cancellous tissue of the
bone, and expanded the thin outer lamina of compact tissue
around it. The structure is that of hyaline cartilage: — the cells
are large, round or ovoid, and* nucleated, — a few are stellate; the
intercellular substance transparent or but faintly granular.

Presented by Professor J. Fayrer.

102. A hyaline enchondroma of the first phalanx of the thumb,

originating in the cancellous osseous tissue of the same, and
developing eccentrically so as to expand the bone, and form an
irregularly rounded tumour, the size of a small orange. Its

structure is identical with that of the last specimen. The

terminal phalanx remains unaffected. No history.

103. Hyaline enchondroma of the first and second (middle) phalanges

of the index finger of the right hand. The tumour is the size
of an orange ; surrounds the phalanges ; is lobulated. The skin

over it is tense, stretched, and at one spot ulcerated. Ex-

amined microscopically, the structure is found purely cartilagin-
ous,—both cells and matrix being well defined.

Presented by Dr. R. K. Mookerjee.

104. “ Tumour connected with the great toe; of three years’ duration.
From a native female aged about 25. The tumour is about
the size of an orange, and ulcerated on the dorsal aspect towards
the tip of the toe.”

This is a typical specimen of enchondroma. The terminal phalanx
is alone involved ; almost the whole of it has been converted
into a soft but coherent, yellowish-white tumour, about the
size of a small orange. The cuticle and true skin are both
greatly thickened and hypertrophied. The nail has apparently
dropped off, and its matrix has undergone an ulcerative papillary
transformation. The section of the tumour is smooth, but not
homogeneous, and the great bulk of its structure consists of pure
hyaline cartilage. The cells are well defined, and in a state of
rapid proliferation in many parts. The intercellular substance
is mostly hyaline or only faintly granular, but here and there
shows traces of fibrillation.

Presented by Professor S. B. Partridge.

105. An enchondroma, the size of a tennis-ball, removed from the
sub-maxillary region of a native male patient, a Hindu, aged
21. “The tumour commenced as a small nodule just beneath

SERIES XVII.]

ENCHONDROMA.

557

the skin below the inferior maxilla, four years prior to removal,
and had grown slowly and without any pain.”

The tumour is lobulated in outline ; firm and resistant on section.
Pale-white glistening nodules or depots of cartilage are visible
even to the naked eye, separated by strands of yellowish fibrous
tissue; and a distinct well-formed connective tissue capsule
invests the whole growth.

This is confirmed on microscopic examination,— the cartilage is of pure hyaline type,
the cell elements and intercellular tissue both well marked. The inter-car-
tilaginous tissue is fibrous and nucleated, and, in parts, groups of gland cells
are^found imbedded, as it were, in it, representing, probably, the remains of
the submaxillary gland included in the morbid growth.

Presented by Professor H. C. Cutcliffe.

106. A large cartilaginous tumour, removed from an East Indian
(male) patient, aged 25. The tumour is the size of a child’s
head, has a firm fibrous capsule, and, on section, has the appear-
ance of a glistening pearly tesselated pavement, — islets, as it
were, of pure hyaline cartilage, surrounded and held together
by narrow intervening bands of fibrous tissue. The consistency
is throughout firm. It is a very typical hyaline enchondroma.

Presented by Professor H. C. Cutcliffe.

107. An ossifying enchondroma from the inner margin of the head
of the right tibia. The growth is about the size of half a
walnut, and has a short broad pedicle ; it is invested by a thin
capsule (perichondrium) ; the basal portion is composed of
spongy osseous tissue, the superficial layers are cartilaginous,
pearly-white in colour, and so transparent that the rosy hue of
the vascular subjacent bone can be readily distinguished through
them. The cartilage is of the hyaline type, the cells are large, and
in a state of proliferation and calcification, i.e., the whole growth
is rapidly ossifying. From an East Indian lad, aged 14.

Presented by Professor S. B. Partridge.

108. A large ossifying enchondroma of the left leg. From a native
male patient. The limb was amputated just below the knee-
joint. The longitudinal section which has been made through
the tumour shows that it is attached to about the lower four
inches of the fibula, and has grown forwards, outwards, and
backwards, from that bone. The posterior and outer aspects
of the tibia are eroded and carious, probably from pressure, and
the whole of the lower end of this bone is rarefied, soft, and
fatty. The tumour is rather larger than the adult head, and
irregularly rounded in outline. The skin over it is thickened
and tuberculated, in parts ulcerated. There is a very firm,
dense, white fibrous capsule, — derived probably from the greatly
stretched and developed periosteum. The cut surface of the
growth presents a partly bony, partly cartilaginous, structure.
The osseous tissue exists in the form of huge stalactitic masses,
the interspaces (and portions of the new bone itself) are filled
with a softer, semi-translucent, bluish-white material, like solid-
ified gelatine. This consists of pure hyaline cartilage, under-

558 ENCHONDROMA. [series xvii.

going rapid osseous transformation. The peripheral portion of
the tumour is composed of a layer of compact bony tissue,
from two to three lines in thickness.

Presented by Dr. Griffiths, Civil Surgeon, Sylhet.

109. An enormous enchondromatous growth, involving the whole of
the left ilium, and constituting a tumour which weighs lilts
11 ozs. On the outer aspect, the skin exhibits three or four
large, irregular-outlined, ulcerated openings, through which
portions of the growth, in a softened and suppurating condi-
tion, were discharged during life. The great bulk of the growth
projects from the outer and posterior aspects of the ilium, but a
portion, the size of the foetal head, filled the fossa llli, lying
beneath the iliac fascia and peritoneum (within the abdomen).
The hip- joint was found healthy.

On longitudinal section through the thickest portion of the tumour,
its structure is seen to be cartilaginous, firm and glistening.
Towards the centre, however, and in other parts, this has broken
down into a pulpy, jelly-like material, and in other situations
again, has acquired greater density from calcification. The bony
tissue of the ilium has almost completely disappeared. What is
left consists of mere irregular masses of cancellous osseous tissue.

From a native male patient, who died in hospital. The tumour was
said to be of twenty years’ growth.

On microscopic examination, proves to be (as its physical appearances indicate) an
enchondroma of the hyaline variety. In sections made, the cartilage
cells are large, swollen, and filled with nuclei. Numerous free nuclei also
exist suspended, as it were, in a hyaline or but slightly granular basis-
substance. In parts calcareous changes are traced, — affecting principally
the delicate connective tissue which binds together the lobules of the
growth, but extending also to the true cartilage. In other situations
marked mucoid changes are apparent — the cells and intercellular substance
being infiltrated by soft, glistening, glue-like material. The broken-down,
jelly-like portions of the tumour (above described) consist of this kind of
metamorphosed cartilage.

110. Enchondroma of the right tibia. The preparation shows an
oval shaped tumour fully the size of an infant’s head, surround-
ing the upper third of fhe shaft of the tibia. A longitudinal
section through the latter has been made, from which it will
be seen that the cancellous tissue of this portion of the bone
is condensed, and the medullary canal obliterated by a growth
of new osseous tissue. The tumour has developed from the
periosteum of the tibia, and perhaps to a certain extent involves
the upper epiphysis, — which is still partly cartilaginous. The
fibula is not implicated, but is imbedded between the anterior
and outer lobulated masses formed by the growth. The tumour-
tissue generally is firm, glistening, and semi-transparent. In parts,
however, it has undergone considerable softening ; and, in the
recent state, some of the localised softenings of the mass felt
through the skin like cysts with fluid contents. Thej’ are due
to liquef active degeneration of the cartilage, the result of
mucoid metamorphosis. Sections taken from the harder and

SERIES XVII.]

FIBROID ENCHONDROMA.

55i>

softer portions of the tumour for microscopical examination
reveal the same principal structure, viz., rapidly developing
hyaline cartilage, with such modifications only as can be traced
to fatty and mucoid changes. The cells are very numerous,
mostly round or oval, and contain two or more distinct nuclei.
The intercellular substance is homogeneous or faintly granular.
The tumour— developing from the deeper layers of the peri-
osteum—has received a capsular investment from its superficial
laminae, which is also directly continuous with the periosteum of
the shaft below the situation of the growth.

Amputation was performed at the lower third of the thigh. The
knee-joint was found quite healthy. There were some enlarged
glands in the groin. The tumour was said to have been of from
five to six months’ duration. The subject was a native boy
aged 12 years.

Presented by Dr. Cayley.

111. A fibroid enchondroma of the lower jaw. The tumour is ovoid
in shape, two and a half inches long, by an inch and a half in
breadth, and fully one inch in thickness. Its outline is lobulated ;
the surface smooth. On section, the growth has a dingy-white
colour, is fibroid-looking, and traversed by numerous delicate
spicula of bone, which form dissepiments throughout its sub-
stance. The latter, on microscopic examination, is seen to con-
sist of fibro-oartilage. The cells are small, rounded, oval, or
irregular, the intercellular material white and glistening, markedly
fibrillated. Two incisor teeth are imbedded in the growth,
which has evidently developed from the alveolar border of the
jaw. The delicate bony dissepiments, above noticed, are pro-
longations downwards of the osseous septa which are normally
interposed between the sockets of the teeth.

112. A fibroid enchondroma of the left superior maxilla, removed —
together with the molar bone — from a Chinese (male) patient.
The surface of the growth is smooth ; its outline slightly lobu-
lated ; it is very dense, firm, and compact on section — cuts like
ligament ; — and is seen to consist (under the microscope) of
fibro-cartilaginous tissue. The cartilage cells are very numerous,
but small, round or irregular, nucleated, and placed in groups or
small depots in the meshes of well-formed interdigitating fibre-
elastic filaments.

113. A tumour removed from the left parotid region of a native
female, aged 60 ; — a growth of twenty years’ duration. The
tumour is ovoid in shape ; as large as the adult head; is much
lobulated ; has a distinct capsule of fibrous tissue ; and a portion
of the superjacent skin of the neck is still adherent to its sur-
face. On section the growth is firm but elastic or yielding, has
a bright glistening semi-transparent appearance in parts, in
others is opaque-white or yellowish ; and here and there portions
are found pulpy or almost diffluent. The cut surface, in the
fresh state, was blotched and stained of a pinkish or purplish
colour from blood. Bands of white fibrous tissue traverse the

560 FIBROID ENCHONDROMA. [sebies xvii.

tumour-substance in various directions, binding together the
lobules of which it is composed.

The general and principal structure, — as seen in sections taken from
several parts of the tumour and examined microscopically, — is
fibro-cartilctginous. The cartilage corpuscles are well-formed,
some large and oval, the majority small and round, many stellate,
and all nucleated. The intercellular material is finely fibrillated.
In the parts which are more opaque and dull-looking, gland-tissue
is seen mixed up with the cartilage ; and, where the growth is
very soft or semi-diffluent, the cartilage has undergone mucoid
degeneration.

Presented by Professor Gayer.

114. A fibro-cartilaginous tumour removed “ from the right cheek of
a Mahomedan male, an adult.”

The tumour is as large as one’s fist, is lobulated in outline, has a
distinct capsule of connective tissue. On section, it is firm,
shiny, and opalescent in appearance for the most part, but here
and there, more opaque and soft. It is found (under the micro-
scope) to consist almost entirely of pure fibro-cartilage. The
cells are well-developed, round or irregular, and nucleated.
The intercellular tissue is finely but distinctly fibrillated. In
parts a little glandular tissue appears to have been included
in the growth, which is evidently a Jibro-enchondroma.

Presented by Professor W. J. Palmer.

115. A rounded and slightly lobulated tumour removed from the sub-
maxillary region of a Hindu (male), aged 40. The growth is
firm, glistening and pale in parts, in others dark-red from blood-
staining (in the recent state). Its structure, under the micro-
scope, is complex: — in parts purely glandular — the acini and
gland-tubules filled with proliferating, granular, small, round,
epithelial cells, of uniform size, and entirely confined within
normal limits. In others, the structure is fibrous — broad and
wavy bands of nucleated white fibrous tissue intersecting
each other in various directions. But the main bulk of the
tumour is cartilaginous — the cartilage cells being angular,
rounded, and spindle-shaped, and the intercellular tissue fibroid —
not hyaline. The growth is therefore, virtually, a fibroid enchon-
droma, originating probably in the submaxillary gland. There
is a distinct and well-formed capsule of condensed connective
tissue.

Presented by Professor K. McLeod.

116. Enchondroma of the phalanges. A preparation showing a finger
amputated on account of a lobulated tumour affecting the
phalanges. The middle phalanx is principally involved. The
substance of the growth is somewhat soft, elastic, and opalescent
on section. It has developed interstitially, i.e., within the bone,
and expanded the osseous tissue around it, but has not penetrat-
ed the superficial soft parts. Under the microscope, the struc-
ture consists of hyaline cartilage, — the only peculiarity observed
is that stellate cells enter very largely into the composition of the
tumour-tissue. No history.

8EBIES XVII. j

ENCHONDEOSIS.

561

H7. Enchondrosis. “A tumour about the size of a pigeon’s egg
removed from the nose of a native (male) patient, aged 35.” It
grew from the inferior border of the cartilaginous portion of the
septum nasi ; had increased slowly and painlessly ; but, at the
time of removal, had almost occluded the nostril anteriorly,
leaving, in fact, only a small space or chink between it and the
alye nasi on either side. The growth is invested by a delicate
but distinct capsule, — a prolongation of the Schneiderian mem-
brane. The structure, microscopically, is fibro-cartilaginous.
Thin sections exhibit well-formed cartilage-cells in a state of
rapid proliferation, but angular and flattened rather than round
or oval ; the intercellular substance is fibrous or fibrillated — not
hyaline. No abnormal or heteroplastic elements are found. The
so-called “ tumour ” is therefore an homologous outgrowth from
the cartilaginous septum nasi, i.e., an enchondrosis.

Presented by Dr. A. Crombie.

118. An osteoid tumour of the upper jaw. The growth has developed
in the antrum, and expanded this cavity around it. A portion
remains in situ, the rest in fragments as removed. The consist-
ency is very hard and firm, — in parts quite bony. The structure
generally is osteoid in character, i.e., consists of embryonic cells
developing into bone,— the latter being scattered in microscopic
islets throughout the growth, but as yet presenting no differen-
tiation into Haversian channels, canaliculi, &c.

119. A large enehondro-sarcoma involving the upper two-thirds of
the left radius, and forming a lobulated tumour the sizo of an
infant’s head. It has apparently developed from the medullary
canal. An expansion of thickened connective tissue forms a more
or less complete capsule for the growth, and is derived probably
from the original periosteum. On section, a mixed structure
is presented ; — portions are semi-transparent, glistening, and
evidently cartilaginous ; others have a yellowish colour and very
soft consistency. The latter, under the microscope, appear to be
made up of closely-packed, small, spindle-shaped, nucleated cells.
The cartilage is of the hyaline type, and much of it shows traces
of ossification. Much central softening of the substance of the
tumour has taken place, and amidst this are found fragments of
the disintegrated radial shaft. The elbow-joint is stiff, but not
implicated in the morbid growth.

Presented by Professor J. Fayrer.

120. “ Left forearm of a Hindu boy, aged seven years, amputated

just below the elbow (the radius being disarticulated at the joint,
and the ulna sawn through) for a large fungating mass situated
a little above the wrist. The tumour is ovoid, about four
inches in length and three in width ; firm below, rather soft and
doughy above.” * * * * * “ An incision

along the inner side of the forearm shows that the tumour lies
under the fascia covering the deep layer of muscles, by which it is

bound down, and to which it owes a great deal of its firmness

the actual tissue of the tumour itself being soft. It is quite
unconnected with the bone. (Colies.)

562

ENCHONDIIO-SARCOMA.

[series XVII.

The superficial portions of the growth are exceedingly soft and friable;— the deeper,
firm and partly osseous, — the bony matter consisting of broad spicula of
spongy osseous tissue. Above and between these, there are portions which
present a glistening cartilaginous appearance ; and, most superficially, the
growth is fungoid and pulpy, — protruding on the palmar aspect of the
wrist.

Microscopically examined, portions of the growth are found purely cartilaginous,
the rest (except the firm osseous tissue) consists of large, round or oval,
and a few spindle -shaped, nucleated cells, with no intercellular material or
formed stroma. At the surface, these are most luxuriant, and closely
resemble the cell-elements of a fungating epithelioma.

The tumour seems to have developed from the periosteum investing the anterior
surfaces of the last inch of the lower ends of the shafts of the ulna and
radius. It appears, on the whole, to be enchondro -sarcomatous, — the basal
osseous formation being imperfect, and a secondary change during the
progress of the growth. (J. F. P. McC.)

Presented Inj Dr. Herbert Baillie.

121. Malignant tumour (encbondro-sareoma) of the upper end of the
ri'dit femur, implicating also the os innominatum of the same
side. It forms a lobulated mass, 26 inches in circumference at
the widest part. The greater portion projected inwards —
towards the perinseum, a smaller portion outwards ; and the
femoral vessels lay in a shallow groove or sulcus between them.
The adductor muscles of the thigh were found greatly thinned,
and stretched over the surface of the tumour. _ The structure—
as seen on longitudinal section — is soft and brain-like ; of pinkish-
white or yellowish colour in different parts, and considerable
portions have broken down into a jelly-like mucoid or colloid
material, and constitute pseudo-cysts. The medullary canal of
the femur is filled with the growth. The neck of this bone
has been completely absorbed, and the cancellous tissue of the
head and trochanters infiltrated with a yellowish or pinkish,
flickering, soft material. All these parts are very soft and
friable, so much so that on attempting to open the hip-joint the
head of the bone fractured readily, and has remained fixed in the

acetabular cavity. .

The upper third of the femur (including both trochanters) is thus
involved in the morbid growth. It is invested by a more or less
complete capsule, consisting, apparently, of the greatly expanded
and developed 'periosteum of the femur,— from the inner surface
(deeper layers) of which, as well as from the articular and
trochanteric surfaces of the bone, the growth has developed.

A large or coarsely alveolar character and soft consistency are presented on section ;
b and on microscopical examination, a mixed structure is revealed. The
alveolated appearance is maintained throughout, — the spaces or alveoli
being formed by the intersection of broad and narrow bands of well-marked
fibrous tissue, enclosing (a) fibro-cartilaginous tissue in a state of rapid
proliferation, and at the same time undergoing extensive mucoid softening
or infiltration; (6) small, round, soft, nucleated cells, lying heaped together
in masses of varying size, having no intercellular substance, or but a scanr.y
homogeneous material ; ana cells of the same type, but spindle-shaped or

caudate. Similar cell elements are also found external to the alveoli, along

the course of the fibroid dissepiments or alveolar walls. The growth
seems to be an enchondro-sarcoma, — a mixed tumour of malignant
character.

series xvii.] OSTEOMA. 563

Secondary growths were found in the lungs, near the surface, forming
slightly projecting nodules, varying in size from that of a pea to
that of a hazelnut. These presented a glistening semi-cartila-
ginous appearance on section, and a microscopic structure strictly
homologous to that of the primary tumour

From a native male patient, aged 60, who died in hospital. The
tumour was of about two years’ duration. ( See further,

“ Surgical Post-Mortem Records,” vol. I, 1877, pp. 389-90.)

122. A large compact osteoma of the lower end of the femur, involv-
ing, apparently, both condyles and the lower fourth of the shaft
of this bone/ It forms a lobulated mass, measuring sixteen
inches in circumference. There is a thin connective tissue
capsule, — probably derived from the original periosteum.

On section, the growth is (almost uniformly) very dense, hard, and
truly bony ; towards the surface, however, there are parts which
show a softer consistency and fibroid appearance. This tissue,
examined microscopically, is fibrous — resembles that of the deeper
layers of the periosteum, — but is also undergoing calcification
and conversion into bone.

Presented by Professor J. Fayrer,

123. Osteoma of the lower jaw. The growth involves the right half
of the body and a portion of the ramus of the jaw, including the
whole thickness of the bone ; is thus as large as one’s fist, and of
an irregularly ovoid shape. It is invested by thickened peri-
osteum. On section the structure is firm and compact for the
most part, but here and there limited portions consist of very
condensed, firm, ossifying, white fibrous tissue. Several circum-
scribed cystic cavities are also seen. These have a shiny,
brilliant-white lining membrane, and are said to have been
occupied by “ gelatinous matter ” (? mucoid).

The tumour was of three years’ growth. The subject — a native male
aged 50.

Presented by Professor J. Fayrer.

124. A large osseous tumour of the lower jaw, removed from a native
male patient, aged 30. It is said to have been of 25 years’
duration. The growth is about the size of the foetal head, and
weighs twenty-five ounces ; is more or less rounded in outline.
The upper third is invested by the mucous membrane of the gum
and that lining the floor of the mouth ; this is opaque-white, dense,
almost integumental in character. Posteriorly, on the right
side, three molars and the first bicuspid tooth are recognised (imbed-
ded in the growth), and on the left, the three molars and both bicus-
pids. The tumour is very hard and firm to the feel. On section
it is seen to involve almost the whole of the horizontal ramus of
the jaw, and is thickest or broadest near the symphysis. The
greatest longitudinal diameter of the growth is 4|", greatest
transverse diameter 3|."

The cut surface shows an almost uniform, smooth, pale-pink, osseous
structure. The bone is hard, dense, and compact , with but
scanty intervening strands of fibrous tissue. This interstitial
material is very small in quantity the great bulk of the tumour

564 OSTEOMA. [series xvii.

is composed of compact bone — pure and simple. A few cyst-like
excavations exist. They are lined by a distinct smooth and
shiny membrane, and their contents (now dropped out) consisted
of a soft, pulpy, and milky-looking material, which, under the
microscope, revealed numerous broken down or round granule-
cells, some squamous epithelium, and a very large quantity of
fatty molecules and granules. The interstitial material (between
the bony masses) consists of firm white fibrous tissue plentifully
infiltrated with calcareous particles, and evidently represents a
transitional condition in the development and growth of the
tumour. Excision of the jaw was performed under chloroform,
and the entire bone (with the tumour attached to it) removed.
The man made a good recovery, and was discharged cured.

Presented by Professor K. McLeod.

125. A large tumour, supposed to be malignant, involving the tibia
and implicating the right knee-joint. The growth was said to
be of eight years’ duration. The subject was a native male,
aged 35. Amputation at the lower third of the thigh was
performed. The patient died.

On a longitudinal section being made through the femur and tibia (see
preparation), the former shows great thinning of its osseous
tissue, with vascularity and pulpy softening of the medulla.
The compact tissue is thin, the medullary canal expanded, but
the lower extremity of the femur is not altered in size, and its
articular cartilage remains unaffected. The patella exhibits
similar changes — osteoporosis of its cancellous structure, which
is filled with soft, oily, and vascullar medulla. The tibia and
fibula are flexed at right angles to the femur. The ligaments of
the knee-joint are all contracted, soft, infiltrated with fat, and
greatly atrophied. The articular cartilage on the head of the
tibia is hollowed out into a cup-shaped cavity, and ulcerated at
its centre.

The tumour consists of a huge osseous mass, occupying the upper
half of the tibia (the fibula being throughout unaffected), having
a circumference of lOf", and projecting forwards and inwards
beneath the skin of the upper part of the leg. Its outline
is lobulated, nodulated, and irregular. The section exhibits a
cavernous osseous structure, — the bone being hollowed out into
a series of larsrer and smaller cavities, which are filled with soft
reddish-brown or reddish-yellow, fatty, medulla-like material.
The largest cavity is about the size of an orange ; another,
nearly as large, bounded by a thick rim of almost compact bone
projects backwards into, and almost completely fills the pop-
liteal space. The medullary canal of the tibia is exposed,
and filled with similar soft, reddish, fatty pulp ; the compact
tissue thinned — so thin, in fact, that a fracture (probably spon-
taneous) has taken place, about two and a half inches below the
limit of the growth or tumour.

On microscopical examination of portions of the pulpy material filling the osseous
caverns, a large number of disintegrating blood-corpuscles, pigment
granules, fat globules, myeloid cells, and small, round, slightly granular

SERIES XVII.]

OSTEOMA.

565

cells (“ embryonic” cells) — are discovered, but no abnormal cell-elements
of any kind.

The rounded, well-defined cavern in the popliteal space is almost entirely filled by
a blood-coagulum, showing no evidences or traces of lamination, and
no direct association or connection with the popliteal vessels.

The cellular and other elements above described, indicate a highly proliferating,
and, at the same time, degenerating (fatty) condition of the normal
medulla, and the growth must therefore be regarded as a true osteoma,
and not a malignant tumour. ( See further, “ Surgical Post-mortem
Records,” vol. I, 1875, pp. 111-12.)

Presented by Professor K. McLeod.

126. Osteoma of the lower end of the right thigh-bone. From a native
boy aged 14.

The preparation exhibits a well-marked compact osteoma of the lower
third of the shaft of the femur, not involving the epiphysis.
It extends about half way up the bone, constituting a pyriform
expansion of the shaft. The medullary canal for this distance
is entirely blocked, — converted into solid, firm, osseous tumour-
tissue. The whole growth is very dense and compact, appears
to have originated in or near the medullary canal, and has
extended centrifugally. The original periosteum is greatly de-
veloped, and invests the surface of the tumour. In parts, imme-
diately beneath the periosteum, the tumour-tissue is softer and
fibroid-looking. It exhibits, under the microscope, all the
characters of so-called osteoid tissue, i.e., a transitional tissue,
— calcified, but not as yet showing differentiation into true bony
structure.

Presented by Professor Gayer.

127. Osteoma of the lower jaw. From a native male patient, aged
40. It was of about eleven years’ duration. The left' half of
the lower maxilla with the whole of the growth has been excised,
and is preserved. The section made through the whole thickness
of the tumour shows its structure to be purely osseous ; — the
new bone is well-formed, dense, and compact. Here and there,
however, are small loculi or spaces filled with soft, opaque,
yellowish material, which consists, under the microscope, of
medullary tissue in a state of fatty degeneration, — large myeloid,
and smaller rounded cells are found, almost all in process of
conversion into “ granule-cells,” an abundance of free fat and
nuclei, and a little blood-pigment.

The patient died from pyaemia. (See further, “ Surgical Post-mortem
Records,” vol. I, 1880, pp. 751-52.)

127a. An osteoma of the upper jaw. The growth involves the
whole of the left superior maxilla, rendering it very mas-
sive, and filling up all the cavities or inequalities on its
inner surface, including the antrum, in which situation it
probably originated, as the structure is densest and firmest
here, and the jaw is bulged out at this spot. The section
which has been made shows that the structure is purely
bony,— firm, compact osseous tissue. Only at the upper part
of the growth, where it projected into the orbit, is the structure

666 SPONGY OSTEOMA. [seeies xvii.

fibroid ; but the fibrous tissue here is also undergoing ossifica-
tion, and therefore merely indicates a progressive slow advance
of the growth in this direction. The cut surface is otherwise
smooth and homogeneous. The tumour is the size of an orange ;
has a somewhat dumb-bell shape owing to a slight constriction
towards its centre. The alveolar margin of the jaw is not
affected ; the teeth are normal and firmly implanted. From a
native male, aged 28. The duration of the growth was five
years.

Presented by Dr. J. F. Mullen.

128. An osseous tumour of the lower third of the right femur. It
forms an irregularly rounded mass, which projects principally on
the outer aspect of the bone. Is very hard and firm to the feel.
On section the structure is spongy or cavernous in character.
The growth has originated from an expansion of the cancellous
osseous tissue of the shaft primarily, the compact outer lamina
undergoing subsequent attenuation. The periosteum of the shaft
forms an investing capsule over the tumour ; is a good deal
thickened in parts, in others is wanting — where projection and
ulceration of the growth outwards have taken place. The spongy
tissue of the condyles is partially involved, but the articular
cartilage has not been reached. In some of the bony alveoli
a soft, yellowish, cheesy or putty-like material may be seen.
This, under the microscope, consists of a granular, oily debris
of round cells, free nuclei, and much fatty matter, i.e., degener-
ated medullary tissue ; — no extraneous or foreign growth. The
tumour is a true spongy or cavernous osteoma.

129. “ A very large exostosis springing from the lower two-thirds of
the femur, removed from a patient at the Sukea Street dispen-
sary by amputation at the liip-joint. It weighed 101b including
the upper third of the healthy femur.” (Ewart.)

A longitudinal section made through the tumour shows that it is a
huge spongy osteoma , which has developed, probably, from the
periosteum of the shaft of the femur, but does not involve the
lower epiphysis. (The shaft has been partially absorbed into the
structure of the growth, and deflected to the right). It is
composed mainly of spongy or cancellous osseous tissue, exhibit-
ing in places deep excavations, which are filled with soft
medullary substance. Towards the periphery of the growth the
bone is more compact, and here and there tipped with cartilage.
It is roughly ovoid in shape ; the surface broadly lobulated.
The skin over it is in parts ulcerated. The tumour seems to
have projected on the anterior and inner aspects of the right
thigh.

The age of the patient is not recorded, but, judging from a photograph
preserved in the museum, he seems to have been a native lad
of from 12 to 14 years of age. The operation was successful.
The boy made a good recovery.

Presented by Professor S. 13. Partridge.

130. A large lobulated growth (about the size of the foetal head),
originating apparently from the superior epiphysis of the left

SEI1IE8 XVII.]

SPONGY OSTEOMA.

567

tibia. On section it is seen to be almost completely osseous, a
thin rim of cartilage — two to three lines in thickness — being found
only at the periphery of the tumour. Superiorly it encroaches
upon, but does not involve, the knee-joint (the structures of which
are found quite healthy). Below it extends for about two
inches along the outer surface of the shaft of the tibia. The
fibula is not implicated. The bony tissue composing the bulk of
the tumour is cancellous or spongy in character. The growth
is evidently an osseous tumour ; it constitutes the so-called
“enchondroma ossificans” of Virchow.

The subject was a native male (Hindu) aged 25. The tumour was of
eight years’ growth, and almost painless.

Presented by Dr. E. Lawrie.

131, Spongy osteoma. A large lobulated tumour, developed from the
head (probably the epiphysis) and upper half of the shaft of the
right fibula ; not involving the tibia, but pressing upon its shaft,
and thus producing a lateral curvature of that bone. The growth
is ovoid in shape ; its surface is invested by the highly developed
periosteum of the fibula, immediately beneath which there exists,
here and there, a rim or lamina of hyaline cartilage, a line or
two in thickness. The upper half of the medullary canal of the
fibula has been obliterated by the pressure of the growth. The
firmest portion of the latter is that which corresponds to the
head of the fibula. Measurements: — (a) extreme length 65*,

( b ) extreme breadth 3%", ( c ) circumference 12'. The tumour
is mor3 or less uniformly osseous or spongy. It is said to
be a growth of only one year’s duration. “ From a native
male on whom amputation at the lower third of the thigh was
performed at the Mayo Hospital.”

Presented by Dr. H. C. Cayley.

132. Osteo-sarcoma ot the right humerus. “ The growth was exceed-
ingly rapid, six weeks in duration according to the statement of
the patient. Amputation was performed at the shoulder-joint.”

The morbid growth involves the whole of the upper third of the humerus,
including its head and tuberosities, and forms a globular tumour
the size of a small cocoanut. On longitudinal section the shaft
of the bone is seen to be completely necrosed, broken up into
rough stalactitic masses, which are exceedingly soft and brittle,
lhe medullary canal is widened and hollowed out, and the
cancellous tissue ot the head and tuberosities has broken down
so as to form a cavity, the size of a small orange, filled with
opaque, pulpy, soft material, and fragments of rough bone. The
cartilage investing the head of the humerus remains unaffected,
and also about a fourth of an inch of the cancellous tissue
beneath it. The morbid growth has originated in the interior
of the bone and expanded it in various directions eccentrically.
The muscles surrounding the shoulder joint — especially on its
outer and anterior aspects — are matted together, and their deeper
layers (those nearest the bone) are in a state of fatty degener-
ation. There is, however, very little morbid infiltration of the
soft parts surrounding the osseous structures.

668

OSTEO-SARCOMA.

[series XVII.

Examined microscopically, scrapings and sections exhibit a closely packed, soft,
cellular structure, having no “ formed” intercellular substance. The cells are
about the size of, or a little larger than, pus-corpuscles ; — very granular and
fatty; the great majority round, a few angular; but no great diversity in
size or shape exists. Many free nuclei, and a great abundance of fatty
granules and molecules make up the rest of the field.

Presented by Dr. J. R. Jackson, Civil Surgeon, Mynpoorie, N. W. P.

133. A malignant tumour of the lower end of the left femur, of about
four months’ duration. From a native hoy, aged 14 years.
Removed by amputation at about the middle of the thigh. The
tumour is intimately connected with the rectus and vasti muscles
on the front of the lower half of the thigh anteriorly, and post
eriorly extends into the popliteal space. Altogether it is about
as large as the foetal head. Its consistency in front (two inches
above the knee-joint) is very soft, and a considerable portion
here has broken down into a shreddy, tattered mass. Below this,
the tumour substance appears to be intimately connected with
the inferior epiphysis of the femur, and also involves the shaft
of the bone for a distance of quite four inches above the epiphysis.
It projects from all these parts in a somewhat fungus-like
manner, and fills the medullary canal of this portion of the
femur. The growth also encroaches upon, and partially involves,
the ligaments of knee-joint.

On microscopic examination, a complex structure is presented by the tumour-tissue.

In its basal portion — nearest the bone — small nodules of both hyaline and
fibroid cartilage are found pretty freely distributed, but the greater part
of the superficial portions is composed of round, spindle-shaped or angular
cell-elements, lying closely packed, and without any intercellular substance.
Large blood-vessels— in parts forming an almost cavernous system — ramify
amidst these soft cellular tissues. Lastly, in parts the structure is more
fibroid,— the fibrous tissue imperfectly fibrillated, and also showing calci-
fication or partial ossification. On the whole, the tumour may be regarded
as an osleo-sarcoma.

Presented by Professor Gayer.

134. Osteo-sarcoma of the right leg. The preparation exhibits a
large, irregularly oval-shaped tumour, involving the upper two-
thirds of the tibia, — the fibula being slightly deflected outwards,
and remaining unaffected. The growth surrounds the bone, is
moderately nodulated, and, on the anterior aspect of the leg,
about two inches below the knee-joint, has made its way through
the skin, and presents here as an ulcerated fungoid-looking mass,
the size of a large orange. The knee-joint itself is not involved,
and the patella remains free.

On a longitudinal section being made through the whole thickness of
the tumour, it is found to have developed, apparently, from the
periosteum, and spread outwards. The shaft of the tibia has
become condensed and thickened ; the medullary canal in the
upper two-thirds of the bone has been almost completely filled
up by firm osseous tissue, and the cancellous structure of the
head of the tibia is abnormally condensed and compact.

SECIES XVII.]

OSTEO-SARCOMA.

669

The consistency of the tumour is not uniform, and its structure varies
accordingly. Portions are very firm and dense, and composed of
fibrous tissue, ossifying cartilage, and imperfectly formed bone.
Others are exceedingly soft and pulpy ; of a yellowish-pink or
bright vermilion colour (in the fresh state) ; and extremely vas-
cular, indeed, exhibiting an almost cavernous structure. Sections
from these softer portions of the growth reveal, under the micro-
scope, an almost purely cellular structure : — the cells are round,
oval, or spindle-shaped, with large nuclei and granular protoplasm,
have no definite arrangement, and no distinct or formed intercell-
ular tissue or stroma.

The skin and subcutaneous tissues are infiltrated on the anterior aspect
of the tumour. The latter is throughout ill-defined, and pos-
sesses no limiting capsule.

From a native male patient, aged 18. The growth was of about nine
months’ duration.

Presented by Professor K. McLeod.

135. The upper two-thirds of the right fibula, showing the osseous re-
mainsofa very large, — probably osteo-sarcomatous, — tumour, which
involved the upper third of the shaft and the head of the bone.
A large mass of stalactitic bone, — forming irregular rugged tubers,
and sharp flattened processes, — may be observed. The osseous'
tissue is imperfectly developed, is more chalky and brittle than
healthy bone, and, moreover, displays no differentiation into
Haversian canals, lacunai, &c. The soft or organic portion of the
growth has been removed, and only its calcareous basis remains.

The whole of the shaft shows evidences of superficial or surface thicken-
ing, while the interior is very spongy, and the cancellous tissue
increased at the expense of the compact (osteoporosis). No
history.

136.

137.

The bony framework or skeleton of (probably) an osteo-sarcoma-
tous tumour. “ Its radiating and acicular character is well
marked.” No history.

“ A reniform deep-seated tumour removed from between the inter-
muscular spaces in the anterior part of the thigh, measuring
four by two inches.” Its outline is lobulated, and it has a dis-
tinct fibrous capsule. On section is waxy-looking, smooth, and
homogeneous ; and, examined microscopically, is found purely
glandular in structure, — small, round, nucleated cells in a narrow-
meshed reticulum of delicate connective tissue. The tumour is a
simple lymphoma.

Presented by Professor R. O’Shaughnessy.

138. A large, lobulated glandular growth, “ removed from the neigh-

bourhood of the left angle of the lower jaw.” It consists of a
series of smooth nodules, bound together by delicate, yet firm
connective tissue, and each possessing a distinct capsule or
fibrous investment of its own. The structure, microscopically
is that of simple lymphoma . 1

Presented by Professor J. Fayrer.

139. Simple lymphoma. A mass of upwards of fifty lobulated and
hypertrophied lymph -glands removed from the axilla, where they

670 LYMPHOMA. [sebies xvii.

formed a large tumour “ of six months’ growth.” These glands
are grouped together by a varying thickness of connective or
fibrous tissue. Some are as large as a potato, the majority
about the size of a pigeon’s egg. Many have been dissected out of
the mass and are merely strung together now artificially. Their
structure is purely lymphoid.

Presented by Professor J. Fayrer.

140. Portion of a large glandular tumour removed from the right side

of the neck of a native female aged 18. “ It consisted of a

number of nodules, varying in size from that of a grape to that
of a small currant, — apparently altered lymphatic glands, — each
surrounded by its own fascial capsule, on slitting up which they
were easily removed.”

“ Under the microscope, scrapings and thin sections showed numerous oil
globules and granules, and very numerous cells about the size of
blood-corpuscles, with granular contents (lymph cells).” (Colles.)

Presented by Professor S. B. Partridge.

141. A simple lymphoma removed from just above the bend of the
elbow (right), in close proximity to the ulnar nerve. From a
native male patient, aged 30. The tumour was solitary, and of
slow growth.

It consists (as seen on microscopic examination) of small, round, lymph-
oid cells, each about the size of a leucocyte or white blood-
corpuscle, and possessing a single or double distinct nucleus.
The intercellular stroma is very delicate, and forms small meshes,
each of which encloses from one to three cells. At the periphery
the structure is denser and more fibroid, and includes a consider-
able deposit of fat.

Presented by Professor H. C. Cutcliffe.

142. Three small adenoid or lymphoid growths removed from the right
popliteal space of a native woman. “ They were situated beneath
the tendons of the hamstring muscles, and caused the leg to be
flexed at more than a right angle. Had existed for about two
years.” Portions of each growth show softening and disintegra-
tion of the tumour-tissue.

Presented by Dr. W. P. Dickson, Civil Surgeon, Dhurmsala.

143. A small, lobulated, glandular tumour from the inguinal region
of a native boy, aged 13 years ; said to be a growth of two
months’ duration.

The tumour consists of a group of hypertrophied lymphatic glands.
There is no abnormal or heteromorphic growth ; the lymphoid
cell elements of the glands are found in a state of proliferation
( simple lymphoma). One gland is particularly firm and cheesy
— (“ tyroma ”).

Presented by Professor Gayer.

144. Glandular tumour from the right side of the neck of a European
seaman aged 30. There were also enlarged glands in the right
axilla and groin, and on the opposite side of the neck. No
history of syphilis. No splenic hypertrophy.

SEBIES XVII.]

LYMPHOMA.

671

The tumour consists of a series of enlarged lymphatic glands, which
vary in size from a pea to a hazelnut, and are bound together
by broad bands of glistening white fibrous tissue.

Microscopically examined, the morbid growth is found purely homologous —no
new cell-elements being observed. The change appears to consist of a
hyperplastic process affecting the normal cervical glands. A few of these
en urged glands exhibit, towards their centres, commencing caseation, but
the majority seem to be still progressively developing.

Presented by Professor Gayer.

145. Tumour removed from the axilla of a native (Mahomedan) female
said to have been growing for the last three months.” It is very
firm and hard to the feel, about the size of a small orano-e and
has a portion of the skin still adherent to its surface. Though
firm, the tumour cuts very easily; and is seen to consist of” a
series of smaller and larger lymph-glands, matted together by
on overgrowth of the normally surrounding connective or fibrous
tissues ; thus, the incised surface presents a nodulated appearance,
the nodules smooth and homogeneous, separated by broad fibrous

These appearances are confirmed on microscopic examination, the
tumour consisting chiefly of lymphoid or adenoid tissue, and is
therefore a simple lymphoma.

Presented by Professor W. J. Palmer.

146. A glandular tumour removed from the left side of the neck of
a native boy, aged 11 years. Duration of the growth five1

Sged. °n the right Skle °f the neck were also

The tumour consists of a mass of lymph-glands varying^ hypertrophied-
a few solitary, the majority grouped together so aSP to forma

lobulated mass, the size of one’s fist. The latter are bound
together by loose connective tissue. The largest growth is
the size of a potato, the smallest about that of a pea 1 on
section, are found to be more or less cheesy P

Microscopic examination reveals a purely lymphoid or adenoid structure
\\ith opacity, granular fatty degeneration, &c., corresponding
to the degree of caseation in different parts of the gland Thf
growth is a simple lymphoma. ° '

Presented by Professor D. O’C. Kaye.

147’ thpP1Sft-rati0f ShKWiuf, a krge Iobulated growth involving
the soft Parts beneath the skin at the bend of the right elbow

arS° thej0in1t’ the laments of which are softened and
partially disorganised, and the osseous structures laid bare and
roughened. The tumour is somewhat oval in shape about- c-
inches in length, and four inches in breadth The Ac'
subcutaneous cellular tissue of the forearm and ‘hand u

brawny thickened condition, which culminates in tho f ^ &
of a more circumscribed tumour-like swelling over the ^ mfatl0n
aspect of the ring and little fingers Tb? the ? °?tenor

and on section, either smooth S
fibroid, and has an obscurely nodulated appearance. S ’ght 7

573

LYMPHADKNOMA.

[sEBIEa. XVII.

On microscopic examination it is lymphoid in structure, consisting of a delicate
connective tissue framework or small-meshed reticulum, in which are lodged
small, round, nucleated cells, of the size and general appearance of
leucocytes.

The tumour-like swelling over the back of the hand has a less distinct structure,
is more fibrous, and shows free infiltration with fat globules and granules,
the remains of red blood cells, and pigment matter ; a condition of parts
indicating, apparently, prolonged oedema with pseudo-hypertrophy of the
skin and subcuticular structures, and perhaps due to obstruction of the
lymphatic circulation by the growth at the bend of the elbow, which
probably originated in the lymph-glands here, but has subsequently
extended to, and implicated, all the surrounding soft structures — (? lymph •
adenoma). No history.

Presented by Professor J. Jackson.

148. “An intra- thoracic tumour, from an Armenian (John Pogose)
aged 32.”

“ The great mass of the tumour is situated between the arch of the aorta
in front, and the right bronchus and its main branches behind.
It embraces the innominate artery and the thoracic portion of
the left common carotid. Above, it reaches the right sub-
clavian artery, and involves the right recurrent laryngeal nerve.
Below, it descends behind the arch of the aorta, hooking round
it, and encroaching upon the left recurrent laryngeal nerve.
Tracheotomy was performed on account of extreme dyspnoea.”

The tumour is highly lobulated ; on section somewhat soft. Its
structure, microscopically, is lymphoid, and consists of well-
defined, small, nucleated cells, held together by a scanty, small-
meshed, connective tissue reticulum.

It has probably originated in the mediastinal lymph-glands, but after
a time has passed beyond them, infiltrating the surrounding
structures as above described. It is undoubtedly a lymph-
adenoma (Jy mpho-sarcoma of Virchow).

Presented by Professor J. Fayrer.

149. Lymphadenoma or Hodgkin’s disease. A large tumour occupy-
ing almost the whole of the anterior mediastinum (a little to the
right of the median-line), and sending forward a rounded
prolongation, which lay beneath the left sterno-clavicular articu-
lation.

The pericardium, both pleurae (but especially the right) the bronchial
glands, and all other adjacent structures, were more or less
infiltrated by material similar to that composing the main
growth. The latter has a smooth surface, a lobulated outline ;
soft consistency ; and, on section, a dull greyish-white colour.
The incised surface is mapped out into rounded or ovoid nodules,
of various sizes, and thus presents a distinctly glandulai
appearance.

On microscopical examination, (when thin sections are made, and carefully brushed
out under water), a very typical lymphoid or adenoid structure is dis-
played — a delicate, small-meshed, connective tissue stroma, with small,
iound ’or slightly oval, nucleated cells; two or three contained in each
interfibrillar space. The cells are uniform in size and shape, and exhibit
no processes or prolongations. , .

An exactly similar structure is displayed by all the surrounding infiltrations of
the adjacent parts above described.

SERIES XVII.]

LYMPHADENOMA.

573

The specimen was taken from a Hindu boy aged 11 years. Two
months prior to his admission into hospital he noticed an
enlargement of the left axillary glands, following upon an attack
of “fever.” The submaxillary next enlarged. Then (a month
ago) he began to experience difficulty in breathing. This
gradually increased, as well as the hypertrophy of the °axillary,
submaxillary, and latterly, of the cervical glands.

I he superficial veins ot the neck, chest, and abdomen were unusually
prominent, full, and tortuous. Marked dulness on percussion was
elicited oyer the whole of the front of the thorax, in the rio-ht
lateral region, and left inter-scapular space. Respiration over all
those parts was weak or absent, and the vocal resonance
inci eased ; in the left front and left lateral regions the breathing
was puerile. He died rapidly from asphyxia and exhaustion.

The r'Sbt Pleura was found> after death, nearly filled with thin, greenish- yellow
sero-purulent fluid. The mesenteric and lumbar glands were specifically’

enkrged rhe spleen was slightly hypertrophied, but free from all
morbid infiltration.

150,

153.

From

154.

155.

151, 152. The mesenteric, axillary, and left submaxillary
glands from the above case of lyinphadenoma, showing morbid
hypertrophy or homologous overgrowth, associated with the
development of the large mediastinal tumour.

A . large mass (the size of a cocoanut) of diseased mesen-
teric, lumbar, and post-peritoneal glands, including portions
also of the _ abdominal aorta, vena cava inferior, pancreas
ileum, &c., inseparably connected with the same, the whole
occupying the umbilical, hypogastric, right lumbar, and inguinal
filfing 1 it ° t lG a^om*nal cavity, and thus almost completely

a native male (Mahomedan), aged 30, who died in hospital
home of the mesenteric glands are enlarged to the size of a hen’s

eg£u consistency> as well as that of the surrounding

infiltrated structures, is soft, and the colour a greyish-pink (in
the fresh state). Microscopic examination reveals homologous
overgrowth — a rapid hyperplasia of the normal adenoid tissue of
the glandular structures involved, with infiltration and matting
together of the adjacent tissues by similar material. Some of
the diseased glands show partial softening from fatty and mucoid
changes,— (lymphadenoma). * J

Ihe spleen from the above case. It is much enlarged (weighing'
3o5 ounces), pigmented, and infiltrated with nodules of pearly
or pinkish-white material, consisting, under the microscope
of rouna nucleated cells, some the size of, others larger than’
leucocytes, with a scanty and indistinct intercellular substance
(often quite wanting), heaped up in large nodules or smaller
granules,— -looking like boiled tapioca-grains, and indicating vcrv
cbaidy, a hyperplastic condition of the normal adenoid tissue
(Malpighian bodies, &c.,) of the affected organ.

Two portions of the small intestine, viz., the duodenum and mrt
of the jejunum, from the same case, showing a small whitish

674

PAriLLOMA.

[series XVII.

nodular or granular infiltration of the mucous membrane.
The glandular structures and the submucous adenoid tissue in
their vicinity are involved. The nodules are of the size and con-
sistency of boiled tapioca-grains. A similar condition of the
whole of the small intestine and of the coecum was found, and
the microscopic structure of the little growths is identical with
that of the morbid infiltration affecting the spleen and
mesenteric glands above described.

156. Two groups of enlarged and infiltrated lymphatic glands, from
the same case of Hodgkin’s disease. Each is about the size of
one’s fist, and was found on either side of the neck, extending
from the base of the skull to beneath the clavicle, surrounding the
common carotid sheath, burrowing deeply into the surrounding
tissues, and in parts intimately adherent to the superjacent skin.
These glands vary in size from that of a walnut to that of a pea ;
are soft, of whitish or pinkish-white colour, and bound
together by a varying quantity of condensed and infiltrated con-
nective tissue.

Similarly enlarged and infiltrated glands were found in the axillae, and
in both groins.

The patient from whom these four preparations (Nos. 153 — 156) were
taken, post mortem , was a Mahomedan coolie, aged 30, admitted
into hospital in a very anaemic and emaciated condition on the
19th December 1879. lie died from exhaustion on ths 31st of
the same month. The case is a typical one of lyniphadenoma or
Hodgkin's disease. Its duration was about five months.
(See further, “ Medical Post-mortem Records,” vol. Ill, 1879,

pp. 383-86.) ,

157. “ An innocent epithelial growth of the leg, of six years’ standing.
It presents a number of small nodular protuberances. It is
about four and-a-balf inches in length and three and-a-half in
breadth. Its general surface is raised from a half to three-quarters
of an inch above that of the surrounding integument. The
excrescences are of a reddish-brown colour. The neighbouring
skin is almost wholly destitute of pigment. The growth increased
more rapidly during the six months prior to its successful removal
than during any previous period of similar duration.” (Ewart.)
The growth is of warty character, and apparently entirely confined
to the superficial (integumental) structures.

Presented by Dr. F. Murray, of Beerbhoom.

158. “ Syphilitic warts removed from the perineum. (Ewart.)

159* « An epithelial tumour ” (warty growth) “ of the prepuce and

adjoining integument. Section demonstrates the disposition of
the condylomatous excrescences of which it is constituted.
(Ewart.)

Presented by Mr. C. Chowdry. # ,111c • i *.1 *u

160. “A horny growth, about four inches m length, half an inch thick

at the apex, and an inch thick at the base, and slightly curved
near the central part. Removed from the posterior portion ol
the thigh of a patient in the native hospital.’ (Rwait.)

Presented by Professor Allan Webb.

SERIES XVII.]

PAPILLOMA.

675

161. Melanosis of the sole of the left loot of a native, aged 50,
removed on the 13th of May, discharged with the wound healed
on 1st July 1863.” (Ewart.) This is a warty growth, not a

■ cancerous tumour, and the only peculiarity consists in its being
darkly pigmented. The pigment-matter is granular in character,
is deposited especially in the hypertrophied rete mucosum,
but also infiltrates some of the connective tissue in the sub-
epithelial layer of the warty structure.

Presented l>y Professor J. Fayrer.

162. “ Large warty growth, removed from above the clitoris in two
portions. It was of twelve months’ duration, and occurred in a
prostitute, aged 40, who suffered from secondary syphilis. Its
peduncle embraced the anterior commissure of the nymphse, the '
right side of the clitoris, and the prepuce. It was removed by-
ligature.” (Colies.)

Presented by Honorary Assistant Surgeon P. A. Minas, Civil Surgeon

TT* ° 1 O /

llissar.

163. A warty growth, the size of a hazelnut, removed from the left
popliteal space of an Eurasian gentleman. It was of long
standing, and produced no inconvenience until the surface became
ulcerated. A thin sanious discharge now issued from the little
tumour, and a good deal of pain was felt whenever, by accident,
it was sharply touched or compressed. The glands in the
groin also began to enlarge. The growth is entirely warty. On
section, a series of papillary elevations succeed each other from
the base to its rounded summit. Towards the central part
softening has taken place, resulting in the formation of small
sebaceous-like cysts. The vascular supply at the short pedicle
and throughout the greater portion of the tumour is very
abundant. There is no extension of the epithelial proliferation
into the subcuticular structures.

164. “ Amputation of the glans penis for a malignant-looking growth.”
This is a large cauliflower-like growth, forming a raised and
vaity coionet round the glans penis. The glans is uncovered
owing to byegone circumcision, and its substance is only
partially involved. The growth springs from the skin of the
penis at the coronary fossa. It is distinctly warty in character
—a series of superimposed, compound, papillary excrescences,
which have a dull-white colour, are very soft and friable, and
composed chiefly of epithelium. The epithelial cells are of lar^e
size, nucleated, and fatty. They are very diversified in shape —
some round or oval, others linear arid much drawn out from
compression ; and a few “ nests ” are also found.

Towards the basal portion of the growth, dilated capillary vessels can be
traced entering into its structure for a short distance. ' The
subpapillary layer of the cutis is not involved ; there appears to
be no tendency to a downward burrowing of the epithelial pro-
liferation. The urethral canal is still patent, and the greater
part of the proper structure of the glans shows no evulences

576 PAPILLOMA. [sebies xvii.

of morbid infiltration. The growth is a papilloma, not an
epithelioma.

“ From a native male patient, aged 45. Said to he of twelve months’
duration.”

Presented by Professor W. J. Palmer.

165. Villous, warty, and pigmented growths, removed from the anal
orifice of a native male child, aged six years. “ They were said
to be of two years’ standing, and bled frequently.”

Presented by Professor D. O’C. Raye.

166. A small papillary tumour of the ocular conjunctiva. The
growth is soft, villous in appearance, and about the size of a
hazelnut. It grows from the mucous membrane (ocular con-
junctiva) close to the margin of the cornea, a portion of which
is overlapped by some of the delicate fringes of the same.

Microscopically, the little tumour is found to consist of delicate
papillary formations conjoined in groups ; they possess a scanty
basis of connective tissue, in which are minute ramifying blood-
vessels ; and an epithelial investment, two to three lines in
thickness, composed of rounded and flattened nucleated cells,
superimposed and closely interlocked.

The growth was supposed to be an epithelioma ; it is, however, a simple
warty structure.

167. “A section of the skull, with a tumour” (psammoma) “ situated
in the left middle fossa, over the dura mater covering that part.
The patient, (Mrs. B.), aged 41, died in the General Hospital.
She had always been temperate in habits, and had enjoyed good
health until two years ago, when she became subject to attacks
of hysteria, which generally came on at night. At this time her
menstruation became very irregular. About five years ago her
eyesight became affected, and she began to lose the power of her
limbs. She also appears to have had some difficulty in making
water. When spoken to, she could not comprehend questions,
not from deafness, but from inability to collect her ideas.”

The growth consists of a flattened ovoid tumour, a little larger than a
pigeon’s egg, which has developed from the inner surface of the
dura mater in the situation described. It is soft and doughy
in consistency ; slightly granular on section ; of a brownish
colour.

Under the microscope it consists of flattened fibres of connective tissue, largely
interspersed with epithelial cells, many of which are flattened or elongated,
and also form spheres or “nests,” and are associated with small corpora
amylacea, and large-sized thin-walled capillaries. The little tumour may
therefore be regarded as a psammoma.

Presented by Dr. S. C. Mackenzie, Presidency General Hospital,
Calcutta.

168. A papillary growth, the size of a nutmeg, attached to the inner
surface of the dura mater which lined the left occipital fossa. It
was found post mortem, on examining the body of a European
seaman, aged 38, who died in hospital from cholera. The brain
substance beneath the growth was quite healthy.

SERIES XVII.]

PSAMMOMA.

577

Examined microscopically, the little tumour consists of fine fibrous
tissue, in which are imbedded numbers of corpora amylacea and
minute calcareous particles. The arrangement of structure is
papillary. The papillae are supplied with delicate capillaries, and
invested by a thin layer of epithelium. The growth is a
'psammoma (of Virchow) or serous 'papilloma.

169. A tumour, about the size of half a walnut, found occupying
the “ sella turcica ” at the base of the skull, being adherent to
the dura mater above, and excavating and producing caries of the
bone below. It has a brownish colour, and a soft sabulous
consistency. It appears to be an abnormal enlargement of the
pituitary body normally lodged in this situation.

The deeper or central portion of the little tumour is composed of a series of minute
lobules, bound together by very delicate connective tissue. Each lobule
, 1S ™.ade “P4 ,of PluinP> darkly granular, nucleated cells. The peripheral
portions of the growth are villous in character, and consist of large
epithelial cells, with bright distinct nuclei, forming a series of papillary
excrescences or tufts, which are very soft and readily broken down. In
the deeper parts of the growth blood-vessels are numerous and large, and
here and there scattered in an irregular manner, are rounded or slightly
o\al opaque bodies— probably corpora amylacea. On the whole, therefore
the structure of the growth conforms most closely with that of the
serous 'papillomata, — -so-called psammomata.

From an aboriginal New Zealander (Maori), who died in hospital.
^*569 70 )*’ ^e(^lca* Post-mortem Records,” vol. II, 1877

170. A portion of the dura mater of the spinal cord, with a small
tumour developing from its inner surface. The growth is a
little larger than a bean : it was found at about the level of the
second dorsal vertebra. The base is broad,- the surface

papillated. It presents a somewhat villous appearance, and is
very soft and granular. ’ b

Under the microscope, a very delicate fibro-nuoleated tissue composes the
bulk of the little growth, imbedded in which are TouXl or
oial laminated bodies,— corpora amylacea, in great abundance
It is therefore a psammoma. ce*

Found on post-mortem examination of the body of a native male, ao„d
do, who died in hospital from tetanus (apparently idiopathic)
There was no evidence of pressure upon the corf by t ie little
tumour, but fixed pain in the back, between the scapnlm was

KeZ'dX^ it ^p. ™ X-XZ

The choroid plexuses from the lateral ventricles of the brain of

Pat‘ent’ Wll° d!ed from chronic bronchitis'
“C- Attached to the same are two small growths about the

size of hazelnuts. They are firm and fibrous-looking ’on section
and in parts distinctly calcareous. S section,

When more minutely examined, and especially i„ microscopic sections
a large number of opaque, concentric or laminated bodies come

ST 7aZrd,Tnf :XrXsX“Cf these’ °the°

apparently of elongated epit.XH cZS

171.

578

ADENOMA.

[series XVII.

tissue, elements. The normal capillary loops and supporting
tissue of the plexuses are exaggerated. The growths described
appear to he small 'psammomata.

172. Two small psammomata developing from the choroid plexus in
each lateral ventricle of the brain.

The structure of these small tumours is quite typical, consisting of
fine, closely-woven, connective tissue, forming papillary-like
sprouts, in which lie a few delicate capillary vessels, a large
number of corpora amylacea of different sizes, a few free nuclei,
and some small round cells.

From a native male, (Mahomedan), aged 35, who died from empyema.
(“ Medical Post mortem Records,” vol. Ill, 1879, pp. 325-2G).

173. A similar preparation. Two psammomata (each about the size
of a small hazelnut) found in the posterior cornua of the respect-
ive lateral ventricles, and developing from the choroid plexuses
in these situations.

Found on 'post-mortem examination of the brain of a native male

174.

175

patient, aged 52, who died of pneumonia.

Adenoma of the mamma. The tumour is about the size
one’s fist. The nipple and superjacent skin are not affected.

On section it is soft, lobulated, and of a brownish-yellow colour,— has
an exaggerated glandular appearance, and, under the microscope,
shows a purely homologous structure. Large acini and tubules
are found, filled with fatty degenerating epithelial cells, and
united by broad bands of connective tissue infiltrated freely
with fatty granules and globules, but exhibiting no new cell
growth or differentiation into stroma, &c. No history.

A chronic mammary glandular tumour (adenoma). A portion
of the skin on one side of the tumour is ulcerated, and a fungoid
protrusion of the latter (about the size of half a walnut) has
taken place at this spot. The rest of the growth is moderately
firm, markedlv lobulated, and has the characteristic pseudo-
cystic appearance of so many of this class of tumours of the
breast. The “ cysts ” vary in size from that of a hen’s egg to
that of a pea, and are filled with solid-looking dendritic vegeta-
tions. These, under the microscope, are seen to be composed
of acini and lactiferous tubules blocked, distended, and distorted
by degenerating epithelial elements. rlhe “cystic growths
are bound together by dense- white fibrous tissue, free from all
abnormal cell-growth.

A large lobulated tumour of the mamma. A portion of the
growth protrudes through the skin in the form of a huge
gelatinous-looking, fungoid mass. On incising the tumour its
true character is revealed, consisting, as it does, of a series o
acini or cyst-like spaces, varying in size from a split-pea to a
hen’s e<rg, and occupied by more or less solid-looking— in

parts quite dendritic— growths. The external fungating mass
has a similar structure, though here the acini are less distinct,
and the fibro-cellular tissue, of which it is mainly composed, is
found (under the microscope) very delicate, highly nucleated,
and much of it undergoing mucoid transformation. With e

176.

—

XEBIES XVII.]

ACINOUS ADENOMA.

579

exception of this part, the consistency of the tumour is
remarkably solid and firm, and its structure is almost purely
glandular (adenomatous) .

177- Fungating adenoma of the female breast. It is said to be a
growth of three years’ duration, and ulcerated through the
skin about twelve months prior to operation. “ The axillary
glands were not enlarged.”

The preparation consists of the greater part of the right mamma,
exhibiting on the outer side of the nipple a large fungating
mass, a series of soft, succulent nodules, of whitish-brown colour,
separated from each other by deep fissures. The nipple is not
involved:— it is large and prominent. Below the level of the
skin the gland-substance is found somewhat atrophied, but
presenting a lobulated appearance— i.e., large acini occupied by
semi-solid pinkish-white material, which can readily be squeezed
out °f them. The acini are connected by bands of white fibrous
tissue. Towards the centre the altered gland-structure has
undergone mucoid softening, and near the base one nodule shows
caseous transformation.

On microscopic examination, the subcutaneous portion of the tumour exhibits a
purely adenomatous structure, consisting of dilated acini, filled with deeen-
erat.ng epithelial elements. Above the skin, the fungoid portion of the

powth is composed of dehcate connective tissue, in parts very abundantly
infiltrated with small round nucleated cells, in others undergoing mucoid
degeneration. & b

On the whole, the histological characters of the tumour are such as belong to no
malignant growth. It seems highly probable that, commencing as a simple
adenoma of the gland, the skin has accidentally become involved and
ulcerated; that thenceforth the tumour-tissue has assumed an exuberant

stSureC°ndltl0n’ bUt Wlth n° “arked 0r sPecific alteration of the original

From a native male aged about 43.
Presented by Professor S. B. Partridge.

178.

An acinous adenoma of the parotid gland. The tummn- io
slightly tabulated, and has a well-defined8 capsule „f cZeetive
tissue, from which prolongations or dissepiments pass inwards
intersecting the growth in various directions, and forming
lobules or acini many of which are large enough to bo readilv
recognised with the naked eye. The majority, however are
microscopic, and all contain a soft, granular substance, constating
of round or spheroidal epithelial cells, in various decrees of
proliferation and subsequent degeneration. No history. °

An adenomatous tumour, the size of an orange, removed “ from
the internal and infenor angle of the left orbit of a woman aLed
38 years. The consistency of the growth is moderately fi™
The structure consists of a senes of very small rounded acM
the walls of which are composed of delicate fibre-elastic ti„ ’
and which contain epithelial cells,— mostly pale atronhied *?
withered , and granular fatty material in g^t abundance ’
Presented by Professor ,T. Fayrer.

179.

580

TUBULAR ADENOMA.

[series XVII.

180. Adenoma of the right ovary. The whole organ is hypertrophied,
and presents a lobulated outline. One large (size of a nutmeg)
and several smaller growths are seen imbedded in the stroma.
They all appear to be circumscribed developments from the
Graafian follicles or gland structure groper of the organ ; and,
on microscopic examination, consist of larger and smaller acini
filled with highly granular and fatty epithelium, i.e., a hyperplasia
or proliferation of the normal lining of these follicles. In some,
the epithelium has almost completely disappeared, a fatty debris
alone distending the dilated and distorted acini. The latter are
bound together by delicate connective tissue with nuclei and
embryonic cells.

These growths are very similar in structure to the localised overgrowths
of the mammary gland constituting the adenomata of that
organ, and hence may be regarded as analogous new formations.

[A myoma, the size of a sparrow’s egg, may be seen developing from the posterior
surface of the fundus uteri, forming a projecting nodule just beneath the
peritoneal investment of the organ.]

Found on post-mortem examination of the body of an East Indian
woman, who died from heart disease, &c. ( See further, “ Medical

Post-mortem Records,” vol. II, 1878, pp. 879-80.)

181. A little oval-shaped tumour, the size of a pigeon’s egg, removed
from the inner canthus of the left eye of a native male out-
patient, aged 85. On section it is opaque and fibrous-looking at
the periphery, and composed here of white fibrous tissue, abun-
dantly nucleated. Partitions or septa are seen passing inwards
from this, so as to divide the tumour substance into a series of
lobules, which have a brownish or greyish colour, and make up
the bulk of the growth. This lobular structure exhibits, under
the microscope, a distinctly glandular character, being composed
of small tubules lined by spheroidal or rounded epithelium in a
state of proliferation and fatty metamorphosis. The little
growth, appears, therefore, to have resulted from an abnormal
hyperplasia of the secreting or gland follicles of the part (the
mucous follicles of the caruncula iachrymalis), and may therefore
probably be regarded as a tubular adenoma.

Presented by Dr. E. Lawrie.

182. The stomach of an “ American ship’s Captain ” who died in the
General Hospital from dysentery. The mucous membrane
generally is thickened, and presents a very curious warty con-
dition, from the presence of a large number of small soft rounded
growths which project from its surface. These are most
plentiful and largest along the greater curvature, and near the
pylorus. Over 150 have been counted. They vary in size from
a small pea to a hazelnut ; are invested by the common mucous
membrane of the stomach, and with it are movable upon the
submucous tissues.

Examined microscopically, each little growth shows, at the periphery,
a minutely papillated conformation, the papillae being covered by
a thin layer of eylindriform or columnar epithelium. Below

8EBIES XVII.]

CARCINOMA.

581

183.

184.

this are found the tubular mucous glands or follicles of the
stomach in an hypertrophied condition,— elongated, and irregu-
larly dilated or expanded, especially at their bases. The gland
tubules are filled with proliferating epithelium, in many cases
ingiily tatty,. in more, perhaps, glistening from mucoid metamor-
phosis, and here and there breaking down into small mucoid
eystE, m which only the fragments or remains of degenerated
epithelial cells are to be distinguished. The tubules are held
together by connective tissue, which is abundantly nucleated, and
contains large-sized capillary vessels. Each of the little tumours
is purely glandular in structure, and may be regarded as a

TrunkLx\den°ma' It: ^ Said that the Patient was a great
Presently MW., H.^ V.^FIemming, Sab-Medical Department.

nahVp10^ fan smaU scTirrhus tumour of the right mamma of a

hai-d"ess-” The

Scirrhus of the left mamma, about the size of an nmno-A
andofsjxnmnfhs’ duration. The patient was 35 years old
Ihe growth was removed on the 23rd November 1863 and t],I
_ woman discharged on the 29th December ” ( Ewart i 1 *

even cicatricial-like in Darts • f brous’ and

most dense and hard. (J. F.’p. MeCMCOn81sfceuc^ 18 everywhere
Presented by Professor J. Fayrer

found extending intn t f ’?• veiT ,iard and firm, and is

a zz

No history. d g7 dense’ and the alveoli well-formed.

186' 0f1v™;Ur0i itm °a £Z/igh\br?St; fid‘o be a growth
The fiimnnr ic • i Vom a Euiopean female aged 42.

rather l^gfr Thin a“ahutn Tt*-"6’, 8ligh‘ly lobuI.ated. ™d

gland situated just beneath the ninnie° 'tL1] ' h 1)ortl°" of the
fenX although

Shusthoaneer.CrOSCOF’ pre,“to al‘ the oharacSLTof’

582

SCIRRHUS CARCINOMA.

[series xvji.

The peripheral lobules of the gland are highly infiltrated with fat, so
that scarcely any trace of their normal (acinous) structure is
distinguishable. Into this fatty tissue prolongations from the
main growth may be traced,— consisting of embryonic proliferat-
ing cells and nuclei.

Presented by Professor S. B. Partridge.

187. Scirrhus of the left mamma. The growth occupies that portion
of the gland which lies just below the nipple, and for a space
of about an inch and a half around the same. The skin, for this
distance, is intimately adherent to the tumour, and cannot be
moved in any way upon it. The nipple itself is flattened and
retracted, and one or two narrow furrows are seen in the skin
starting from this spot and producing a dimpling of the surface.
The tumour is irregularly and slightly lobulated, and is seen
on section to involve the whole antero-posterior thickness of
the gland, burrowing also into the surrounding cellulo-adipose
tissue. It cuts like cartilage, is intensely hard, firm, and resist-
ant. In appearance is fibrous — of a dense white colour, and
very cicatricial towards its centre.

Sections from this part reveal, under the microscope, very little else than closely-
woven, thick, white fibrous tissue, with a lew elastic filaments, and much
fatty, pigmentary, and granular matter ; only here and there can traces
of highly degenerate, fatty, closely packed, epithelial elements be observed;
but sections from the periphery exhibit a greater or more abundant cellular
proliferation ; yet even here the stroma is most dense and well-marked.
The epithelial cells, — found in conglomerate masses, — are polymorphous,
mostly round or angular, highly fatty. An abundant small-celled or nuclear
growth is seen insinuating itself widely between the muscular fasciculi
of the pectorals (fragments attached to and removed with the growth), and
into the surrounding adipose tissue. The tumour is undoubtedly scirrhus,
very typically hard, fibrous, and cicatricial, and shows evidences of com-
paratively slow growth.

Presented by Professor T. E. Charles.

188. Carcinoma of the right breast. “ From a Mahomedan female,
the mother of two children. The growth is of twelve months
duration, and was painful, but there was no marked cachexia.
Catamenia regular. No hereditary taint.”

The preparation exhibits the whole of the breast as removed by
operation. The skin is much involved, showing an irregular-
outlined, unhealthy-looking ulcer, with deeply eroded margins,
situated just below the nipple. The latter is retracted, superficially
excoriated, and surrounded by a raised and tuberculated rampart
of diseased tissue. The whole gland seems to be implicated.
It is atrophied, has a brownish-white fibrous appearance, cuts
firmly, and feels hard and stony. There is no definite boundary
to the morbid growth ; it invades the skin above and the
pectoral muscles below (fragments having been removed with
the breast).

On microscopic examination, all the characters of true scirrhus carcinoma are well
displayed , and the stages of development of the growth can be traced in
even a single section. Jioth stroma and cells are particularly well-marke .

SERIES XVII.]

SCIRRHUS CARCINOMA.

683

The subjacent muscular and cellulo-adipose tissues are found partially
invaded by germinating cells and nuclei.

Presented by Professor Gayer.

189. Scirrhus tumour of the left mamma. From an East Indian
female, aged 42.

“History. The patient is the mother of six children, of whom the youngest, aged
6 years, is alone alive. Noticed a small nodule in the left breast, a little
above the nipple, about a year ago. It was not painful at first, but has
become so during the last three months. The glands in the axilla are not
at all enlarged. There is marked retraction of the nipple. General health
pretty good. Menstruation regular. No history of syphilis.”

The tumour, consisting of the diseased gland, the superjacent integu-
ment, and the subjacent cellulo-adipose tissue (with a few frag-
ments of the pectoral muscles), forms a mass of oval shape, the
size of a small orange. The nipple is a good deal retracted, and
the skin around it puckered and contracted. No ulceration
exists. The growth is nodulated, very hard and firm. Fibrous,
and yellowish- white on section.

Examined microscopically, the structure is very typically that of scirrhus cancer,
though at a somewhat early stage of development. The acini and lactiferous
tubules of the gland are thickly filled with small, round or slightly angular,
nucleated cells, which nlso infiltrate the connective tissue for a variable
distance around these structures, and are seen in some sections to be still
further prolonged, in radiating lines of nuclei (within the lymphatic
channels) into the adjacent cellulo-adipose tissue. The gradual transform-
ation of the glandular connective tissue into cancer-stroma is also very
clearly displayed in some sections.

Presented by Professor Gayer.

190. Tumour of the right mamma. From a European female, a°-ed

about 38 years. °

The whole of the breast was excised, and is preserved. The nipple is
seen to be enlarged, rugose, and retracted ; the areola much
wrinkled, but not ulcerated. On incision, from a quarter to half
an inch of fat exists beneath the skin (except just below the
nipple). The gland-substance is moderately firm (not hard)
in consistency, of a greyish-pink colour, and more wasted-looking
than normal. °

Microscopic sections exhibit all the characteristics of true scirrlius
carcinoma. The stroma and cells are both well-formed, the
latter in great abundance, and displaying both rapid proliferation
and granular fatty degeneration.

Small cells or nuclei are seen to branch out into the connective tissue
spaces surrounding the cancerous growth. The tumour is a
rapidly developing scirrhus cancer.

Presented by Professor T. E. Charles.

191. Cancer of the breast, removed from a native female, aged 40.

“ The tumour is of one year’s growth. The first indication noticed was a hard
nodule, the size of a betelnut, on the outer side of the mamma It was
rather tardy in its progress during the first ten months, but siuce'then has
increased rapidly. The skin over the tumour is adherent, and has a
somewhat dusky hue. There is complete retraction of the nipple. The

SCIEEHUS CAEdNOMA.

[series XVII. ,

axillary glands on tlie affected side were distinctly enlarged and swollen.
There was little or no pain at first, but the patient suffered excruciating
torture during the latter period of the growth. No history of family
predisposition to carcinomatous affections.”

This is a very rapidly developing scirrhus cancer of the mamma. The
whole gland is hypertrophied, but only that portion immediately
beneath the nipple, and consisting of a nodule about the size of
an orange, shows marked specific changes under the microscope ;
these are very characteristic. The consistency is firm, but not so
dense and resistant as is usual in scirrhus. In sections examined,
the cell proliferation is exceedingly abundant ; .tlrn stroma well
formed, but scarcely so broad and perfect as ordinarily met with.
The alveoli are distinct ; crowded with polymorphous nucleated
cells, — the prevailing type, however, being round or oval. All
exhibit granular fatty degeneration. The axillary glands— removed
at the same time as the breast, but not preserved — were indurated
and slightly enlarged ; showed irritative hyperplasia of both
stroma and cells, and, in parts, an epithelial-like transformation
of the latter, indicative of commencing cancerous infiltration.

j Presented by Professor K. McLeod.

192. A scirrhus tumour of the right breast. From a native female
(Hindu), aged 40 years. “ It had been growing for the last eight
months. ” The skin over the mamma is considerably involved,
as were also two axillary glands (not preserved), which were
removed at the time of the operation.

The morbid growth implicates almost the whole gland. The nipple is
retracted; the skin around it nodulated and superficially
ulcerated. On making a longitudinal section through the
mamma, the central portion of the gland is found very soft, pulpy,
broken down into a pultaceous, pinkish- white, fiocculent debi is.
Around this are nodules of the same colour, but firm and fibrous-
looking. Sections taken from these exhibit a true scirrhus
structure, but both cell elements and stroma are much disoigan-
ised and disintegrated from very extensive fatty degeneration.
The gland-tubules as well as the acini are involved in the growth ;
and, at the base of the mamma, the pectoral muscles and
cellulo-adipose tissue here situated are thickened and infiltrated

with cancerous germs. . . _ .

Presented by Assistant-Surgeon Earn Moy Rai, Bhowampore Dispen-
sary, Calcutta. .

1Q2 Recurrent scirrhus of the mamma. The preparation shows the
return of scirrhus growth in the cicatrix left by the first oper-
ation, and in the adjacent sub-integumental structures. The whole
of the mamma was removed nine months prior to this second
operation. On microscopic examination, the diseased cicatrix
now exhibits (a) an abundance of nucleated white fibrous tissue,
combined with a few elastic filaments; (6) much fat, globular and
molecular ; (c) a series of scattered depots composed of round or
oval nucleated cells, from which, as separate centres, small cells
or nuclei are seen radiating in all directions into the surrounc ing
connective tissue. There seems therefore to be no doubt as to
the return of the growth. ( See also next prep., No. 194.)

Rf ,

series xvii.] RECURRENT SCIRRHUS CANCER. VY 585

■ ; V ./

194. Recurrent scirrhus cancer, from the same case as the preceding
preparation. A nodule of partly cicatricial, partly cancerous,
tissue is preserved. It was removed about four months after the
second operation — described above (see prep. No. 193). On
microscopic examination, firm white fibrous tissue is found, with
looser or laxer connective tissue abundantly infiltrated with
nuclei; and scattered small deposits of epithelial cells (with
large round distinct nuclei) arranged in parallel rows in the
meshes of a well-defined stroma. A large amount of fat in the
form of lobules, free granules, and infiltrating molecules, makes
up the rest of this recurrent growth. The cancer germs left
after the second operation have proliferated in and near the
cicatrix, and have spread even more widely than before.

The patient did not long survive this third operation. After death,
small cancerous nodules were found in the liver, and displayed
a very typical structure. J

The history of this case is interesting. The patient was a European female
aged 51. Amputation of the breast for scirrhus of three months’
duration was performed on the 30th September 1875 ; the growth recurred
(prep. No. 193), and was removed again on the 29th June 1876; a
second recurrence took place in situ , and necessitated a third operation
on the 21st October 1876. Soon after which she died, and secondary
deposits were found in the liver on •post-mortem examination. The total
duration of the disease was, therefore, about sixteen months. (J. F. P. McC.)

Presented by Professor S. B. Partridge.

195. “ A fungating medullary tumour of the right female mamma of
one year’s duration. Behind, in the centre of the breast, it has
undergone softening, degeneration, and conversion into a cavitv.”
(Ewart.)

Presented by Professor J. Fayrer.

196. “ A medullary tumour removed from the breast. In some
portions its section presents a fine spongy appearance. There is
a melanotic discolouration of the skin in the immediate vicinity
of the nipple.” (Ewart.) The latter is due to the formation
of a superficial slough in this situation.

The microscopical structure of the growth is that of true enkephaloid cancer, -
both stroma and cells are typical. (J. F. P. McC.)

197. Carcinoma medullare of the ball of the eye, leading to its com-
plete disorganization. The section shows portions of the
sclerotic and choroid pigment.” (Ewart.)

The tumour on section has a yellowish colour and soft consistency.
The growth appears to have developed from the sheath of the
optic nerve and sclerotic coat. Its structure, under the micro-
scope, is that of enkephaloid carcinoma, — (not glioma)

198. A similar preparation. A small lobulated growth attached to the
posterior half of the sclerotic, pressing upon and producing
flattening of the eyeball, and complete disorganisation of its
contents. Its structure is typically enkephaloid— both as regards
stroma and cell-elements. No history.

586

ENKEPHALOID CAKCINOMA.

[SEEIES XVII.

199. “ A lobulated medullary tumour of the testis in the inguinal
canal.” (Ewart.)

The structure is characteristically enkephaloid, and the morbid growth
most luxuriant. The seminiferous tubules have almost com-
pletely disappeared ; those that remain are found collapsed, and
tilled with mere fatty granular debris.

Presented by Professor J. Fayrer.

200. “ An ulcerating fungus lisematodes of the left hand. It has
been injected. The points at which the injection has escaped
indicate the situations where haemorrhage occurred during the
life of the patient.” (Ewart.)

201. “ An ulcerating and fungating” (enkephaloid) “tumour of the
left foot. The great toe has been removed. The growth, which
is circular, and measures about three inches in diameter, is raised
an inch above the skin, and involves the metatarsal bone of the
great toe.” (Ewart.)

202. Enkephaloid tumour of the antrum. It projected from the
anterior and right lateral aspects of the root of the nose, just
beneath the skin, to which it was firmly adherent, and through
which it had ulcerated at a spot corresponding to the inner
canthus of the eye. The patient, a native male, aged about
35 years, died from cerebral meningitis and abscess of the brain.
The tumour was dissected out post mortem. It is seen to be
about the size of a turkey’s egg, soft, lobulated, brain-like in
appearance and consistency. Exhibits all the structural charac-
teristics of enkephaloid cancer.

The growth seemed to have originated in the right nostril, proceeding either
from the antrum or the right half of the ethmoid, and spreading in various
directions. One process or prolongation extended backwards into the
pharynx; another forwards, filling the anterior nares ; a third occupied
the whole of the antrum, and had produced dilatation and bulging of this
cavity, with great consequent deformity of the right side of the face; a
fourth entered the orbit along its inner wall, displacing the eyeball out-
wards. the whole of the vomer, the right half of the ethmoid, including
its perpendicular plate and cribriform septum, both nasal bones, and the
inner wall of the right orbit, had been almost completely absorbed, and by
this means the tumour had made its way into the skull, pressing upon the
brain and membranes (anterior frontal lobe), and exciting the inflamma-
tory changes which were the immediate cause of death.

203. A malignant tumour of the lower end of the right femur. It
is the size of a melon, has a smoothly lobulated outline, and
very soft consistency. On a longitudinal section being made
through the shaft of the femur, the growth is found to involve
its lower third. The shaft and condyles are expanded so greatly
that only a thin rim or shell of either osseous tissue . or cartilage
constitutes the boundary of the growth, and even this is deficient
in parts. The whole of the lower extremity is seen hollowed . out
into a series of huge caverns, with very thin bony partitions,
and filled with a soft, pulpy, gelatinous, pinkish or yellowish
coloured material, or with fluid blood.. The tumour encroaches
upon, and has implicated the knee-joint. The epiphysis and
shaft of the tibia are not affected, but their cancellous tissue is

SERIES XVII.]

COLLOID CARCINOMA.

587

abnormally soft and vascular. The whole of the medullary canal
of the femur, and even the cancellous tissue of the great
trochanter, are infiltrated with soft, reddish, gelatinous material,
like that composing the hulk of the tumour. From a Hindu
hoy, aged 15 years. The disease was of five months’ duration.
The glands in the groin were enlarged and infiltrated, and
there was marked cachexia. During life, distinct pulsation was
felt, and an aneurismal-like bruit heard, over the greater part of
the tumour. Amputation was performed at the hip-joint.

On microscopic examination, all the characters of a rapidly growing enlcephaloid
cancer are well displayed. Sections taken from different parts of the
growth exhibit a highly cellular structure ; — the cells are large, polymor-
phous, and nucleated ; they are imbedded in a delicate reticulum, which
forms imperfect alveoli. There are numerous free nuclei also, and cells in
process of division and endogenous multiplication; blood-vessels are large
and plentiful. Portions of the growth are hollowed out so as to form
caverns, which are occupied by blood or by colloid material.

As far as can be ascertained by careful examination, tho growth has originated
within the shaft of the bone, — probably in the medulla at the lower
extremity ; has then proceeded centrifugailv, absorbing and expanding the
osseous tissue of the shaft and lower epiphysis, and involving the knee-joint
and surrounding soft structures. The tumour is a true enlcephaloid
carcinoma.

Presented by Professor Gayer.

204. Colloid carcinoma. A portion of the great omentum and the
right ovary infiltrated with a soft, flickering, jelly-like material,
which displays, under the microscope, all the characters of
alveolar or colloid cancer. The stroma is soft and spread out,
consists of gelatinous connective tissue forming intercommuni-
cating loculi or alveoli of various sizes. These are either entirely
filled, with colloid — colourless and homogeneous, or exhibit the
remains of polymorphous epithelial cells, infiltrated and surrounded
by similar material.

Taken from a native female, aged about 40.

Presented by Moulvie Tameez Khan, Khan Bahadoor, Lecturer on
Medicine, Campbell Medical School, Sealdah.

205. t olloid carcinoma ol the ovaries. Both these organs and the
Fallopian tubes are involved in the disease. Two large, globular
masses are thus produced rather larger on the left than right
side. Combined, they filled the hypogastric, inguinal, and umbil-
ical regions, displacing the intestines upwards and to the right.
Lach growth is invested by the peritoneum, which was highly
vascular, injected, of a pinkish or purplish colour.

Each tumour is partially cystic, — the greater portion, however, semi-
solid, and on section gelatinous and opalescent in appearance.
From a native female, aged 40 years.

Under the microscope the structure is that of true colloid carcinoma,— most typic-
ally and distinctly displayed. A well-formed cavernous stroma composed of
delicate fibrous tissue, and filled with large polymorphous epithelial cells •
the latter imbedded in much gelatinous, flickering, white-of-egg-like
material. The colloid substance has varying shades of colour,— from bluish-
white to pink and yellow. It swells in water and becomes slio-htl v
opaque. Is clear and transparent in glycerine; does not dissolve in, but

588

COLLOID CARCINOMA.

[SEEIES XVII.

becomes more hyaline, on the addition of acetic acid. In parts, blood
extravasations of considerable size appear to have taken place, the alveoli
containing granular coloured debris and haematoidin crystals.

( See further, “ Medical Post-mortem Records,” vol. I, 1875, pp. 807-8.)

206. The whole of the right mamma and the axillary glands (of the
same side) removed by amputation and dissection for colloid
carcinoma. The subject was a native female, aged about 4-0.
The growth was of six months’ duration. “ The general health
of the patient was good, and no family history of cancer existed.”

The tumour consists of the right mammary gland with the superja-
cent skin, and a small portion of the subjacent fatty tissue and
pectoral fascia. In the former, two ulcerated openings— with
a thin intervening bridle of undermined integument— are seen, a
little to one side of the nipple. The latter is short and flattened,
but not much retracted. Through the ulcerated openings soft,
shreddy, tumour-tissue protrudes. On section, the whole of the
gland appears to be involved. The central portion and that just
beneath the nipple are very soft, almost diffluent, and con-
sist of a series of cyst-like formations, varying in size from a
millet-seed to a pigeon’s egg, and filled with opaque-white,
yellowish or pinkish, semi-fluid (pultaceous) material, having a
mucoid or gelatinous consistency. Towards the circumference
and base of the tumour the growth is firmer, and the cut surface
has even a fibrous appearance, but is also seen to be infiltrated
with small cysts, which have glue-like or mucilaginous contents.

The axillary glands which have been removed in mass, and which are
found closely matted together, display much more markedly a
cystic arrangement of structure. Very little normal gland-tissue
remains, but the whole mass consists of a series of cysts, varying
in size from that of a sago-grain to that of a hazelnut, and their
contents are either semi-solid and pulpy, or quite fluid ; in colour,
white, pinkish or brown; in consistency, jelly-like or mucoid.

Some of the soft pulpy contents of the mammary cysts being examined micros-
copically, consist of epithelial cells in great abundance, but mostly
degenerate — the nucleus absent, the protoplasm granular or swollen, and
infiltrated with transparent glistening globules. Much free semi-trans-
parent material of the same kind, with fat granules and shreds of fibrous
tissue are also seen. The epithelial elements are round, oval, angular,
variously distorted, and of all sizes.

Sections from the firmer portion of the tumour-substance display all the characters
of colloid carcinoma. The alveolar structure — formed by the widening out
of spaces in a fibrous stroma — is well developed, and the alveoli are densely
crowded with epithelial elements heaped together in an indifferent manner,
and suspended in a transparent, homogeneous or hut slightly rippled, glue-
like or gelatinous material (colloid). Many of the cells are also infiltrated
with the same. The cells are polymorphous, and of varying size. A great
many arc cylindriform, and either separate or in groups of from three to
twenty or thirty. Others are squamous and flattened; some quite small.
In some the nucleus still persists, or two or three nuclei exist; others are
non-nucleated and granular. The stroma is soft and succulent-looking, and
is also infiltrated with colloid globules. The lymphatic glands are similarly
transformed. The cyst-like cavities are filled with colloid and cell-elements
or colloid oniy. The cell-elements are of transitional character, i.e., from
ordinary lymphoid corpuscles to large, infiltrated, epithelial masses.

SEBIE8 XVII.]

EPITHELIOMA.

589

The specimens afford an excellent illustration of colloid carcinoma of the mamma
with secondary infiltration of the nearest lymphatic glands.

Presented by Professor Gayer.

207. “A small epithelial cancer removed from the lower lip of
a European sailor, 35 years of age. The growth was of
eight years’ standing, and it was probably for some years
quite innocent in character. The wound healed ; but the man
soon returned to hospital with a large swelling underneath the
angle of the jaw, which proved to be a rapidly developing
medullary cancer. This opened, fungated, and caused several
attacks of haemorrhage. The patient died from asthenia, with
pulmonic symptoms, and one lung was discovered to be
gangrenous.” (Ewart.)

'Ilhs is a little flattened tubercle or button-like elevation, the size of a hazelnut,
with a granular papillafced surface. It is somewhat constricted at the base|
and separated by a narrow but deep groove from the subjacent structures
of the lip. Examined microscopically, the structure is truly epithelioma-
tous, and the mucous glands and muscular tissue of the lip immediately
below it are found deeply infiltrated with small round germinating cells
(J. F. P. McC.) &

Presented by Professor J. Fayrer.

208. “ Epithelial cancer over the middle finger of the left hand in a
state of ulceration.” (Ewart.) No history.

209. “ A cauliflower epithelial tumour of the prepuce, and of a small
portion of the integument of the dorsum penis. The anterior
part of the glans, in which the meatus uriuarius is seen, is free
from disease.” (Ewart.) No history.

210. “ An epithelial cancer of the prepuce. The glans penis and other
sort parts remain unaffected.” (Ewart.)

Presented by Professor K. O’Shaughnessy.

211. Epithelioma of the prepuce and glans penis forming a villous
and tuberculated mass, the size of a small orange. A glass rod
indicates the situation of the urethra, the anterior portion of
which has been laid open by sloughing of a portion of the glans.
I he structure is that of true epithelioma, extending deeply into
the substance of the glans penis and corona glandis, and also
involving the adjacent corpora cavernosa. No history.

212. “ An epithelial cancer removed from the lip of an aged native

of Hooghly.. The growth is about four inches long, two broad, and
one inch thick. Its external surface presents a series of excres-
cences placed against each other like the stones of a pavement ”
(Ewart.) 1

Presented by Dr. C. Palmer.

213= A preparation showing a large fungating tumour occupying the
soft parts on the anterior aspect of the upper third of the left
leg and reaching down to the tibia below. The fibula (of which
only a small portion has been preserved) remains unaffected

I he growth possesses all the characters of true epithelioma, - the “ nests ”
being particularly large, and many of them quite visible to the
naked eye in sections made through various portions of the

690

EPITHELIOMA.

[series XVII.

tumour. The latter has probably developed in the shin and
subcutaneous tissues, and extended downwards to the bone. The
cancellous structure of the upper extremity of the tibia and a
portion of the medullary canal are occupied by the morbid
growth ; the former is softened and partially excavated.

“ The disease occurred in a native, 50 years of age, and was of only
one year’s standing.”

Presented by Professor R. O’Shaughnessy.

214.

215.

Epithelioma of the scalp. The growth is about four inches
in length, and two and a half inches in breadth ; has a flat-
tened base, and a remarkably papillated, fungoid-looking surface.
The structure, microscopically, is that of true epithelioma. No
history.

“ Portion of the left cheek, and half the body of the correspond-
ing lower jaw, removed for malignant disease, involving the
bone and forming a penetrating and fungating ulcer of the
cheek. The patient left the hospital well.” (Ewart.)

The structure of the growth is typically epitheliomatous. Under the microscope,
characteristic epithelial tubules and nests are found, the latter in great
abundance. It seems to have commenced or originated in the mucous
membrane of the mouth, and to have extended outwards to the skin, and
inwards to the bone (lower maxilla). (J. F. P. McC.)

Presented by Professor S. B. Partridge.

21G. Epithelioma of the lip. The growth consists of an ulcerated
nodule the size of a hazelnut; soft and creamy on section,
but firm at the base. Under the microscope it exhibits large
epithelial cylinders or columns proceeding from the cutis vera
downwards into the subcutaneous tissues; they are composed
of large nucleated epithelial cells, irregularly and profusely
heaped together, and also forming “globes” or “nests.” The
sub-integumcntal connective tissue is lreely infiltrated with
small round cells and nuclei, indicating active and rapid
extension of the growth. “From a native male aged
about 40.”

Presented by Professor J. Fayrer.

op 7 Epithelioma ol the left foot. From a native (Hindu) male

patient, aged 40. The growth occupies a large portion of the
sole and inner side of the foot. It has a broadly lobulated and
fungoid appearance ; is soft and succulent ; highly vascular ;
affects the skin, subcutaneous cellular tissue and plantar fascia,
but has not reached the metatarsal or tarsal bones. Under the
microscope, it consists of luxuriant epithelial solid tubules and
numerous laminated nests, &c., — a typical epitheliomatous
(cancerous) structure.

Presented by Professor J. Fayrer. .

nio Epithelial cancer of the skin and subcutaneous tissues of the

leu gradually deepening and involving the bone (tibia), which
subsequently fractured from a very slight accident (concussion)
From a native male (Mahomedan), aged 45. The patient had
suffered from syphilis.

Presented by Professor H. C. Cutcliffe.

SERIES XVII.]

EPITHELIOMA.

591

219- Epithelioma of the skin. The growth consists of an ulcer the
size of the palm of the hand, with raised, irregular, and fungoid
margins. It was situated in the left loin, just above the crest of
the ilium, and about an inch and a half from the spine. It
commenced as a small cutaneous tubercle at this spot, sixteen
months prior to removal. During the last two months had
ulcerated and spread rapidly.

On microscopical examination, a well-marked epithcliomatous (cancerous)
structure is exhibited in all sections taken from the growth.
From a Hindu male aged 42.

Presented by Professor H. C. Cuteliffe.

220. A portion of the lower lip of a European (Irishman), aged 65,
showing a flattened epitheliomatous growth, partially ulcerated.
It is said to have been of only one year’s duration. The patient
was an inveterate pipe-smoker.

Microscopic examination reveals well marked epithelial columns and
nests, with diffuse nuclear infiltration of the subcutaneous
cellulo-adigpse structures. An indurated and enlarged lymph-
gland was removed from below the jaw, and is preserved with the
extirpated lip.

Presented by Professor S. B. Partridge.

221. Epithelioma of the penis, of eight months’ growth. From a
European aged 32.

The anterior half of the penis, which has been amputated, presents a
bulbous appearance, and is swollen and enlarged to the size of
a small orange. The disease affects chiefly the prepuce, the
antenor orifice of which has a very foul ulcerated margin, — the
edges everted, hard, and brawny. Within them the expanded
and partially ulcerated glans penis is observed, and portions of
t le same are also protruding through ulcerated openings in the

pie puce (which has become more or less adherent) at the level
of the corona glandis.

Under tlie microscope, sections taken from both prepuce and glans penis exhibit very
markedly and typically all the characters of true epithelioma. The cuti-
CU *!! WCI rophy is very great in the former, and composed of large, closeiy
p.ic *e , mononucleated epithelial cells. These becoming smaller and
rounder, are seen to descend in long processes between the papilla? into the
ti ne cutis and subcutaneous tissues, and large numbers of epithelial nests are

observed m both the superficial and deeper layers of the sections. At the

. gins o ie nnger-glove-likc prolongations, many small, round, free nuclei
are seen, indicating peripheral or lateral growth as well as vertical. In the
.th.e f1™8 Pen.is “ore fibro-elastic tissue is visible, and the
,, V8re 1“ooddedin this, and also surrounded by embryonic developing
s. e giowth here is highly vascular, — the arteries large and dilated.

Presented by Professor W. J. Palmer.

222.

This

Epithelioma of the penis of about a year and a half’s duration
Removed from a native male aged 50. (There was a history of
syphilis,* and the glands in both groins were enlarged),
preparation exhibits the glans penis uncovered Except below
where a portion of greatly thickened and ulcerated (also partially
perforated) prepuce remains adherent. Beyond the elans
involving the whole corona glandis and first inch of the corpora

592

EPITHELIOMA.

[series XVII.

cavernosa, is an indurated rugged mass of diseased growth. The
orifice of the urethra is small ; the fossa navicularis almost
obliterated ; and the urethral canal beyond this narrowed, from
encroachment and pressure of the cancerous growth. At this,
its densest and most developed situation, the appearance on
section is opaque- white, granular, and friable, intermixed with
blotchings and stainings from blood extravasation. Microscopically
examined, the surface of the growth is found undergoing inflam-
matory softening and disintegration,— the epithelial proliferation
here being largely combined with pus corpuscles and shreddy deb) is.
The deeper strata show very characteristic cancerous transform-
ation, i.e., epitheliomatous structure. Large nests, with abundant
nuclear proliferation, and a deepening of the papillary layer to
form solid epithelial prolongations or processes, which extend
into the cutis vera and subcutaneous tissues — are all well marked.

Presented by Professor Gayer. ?

223. Epithelioma of the scalp, said to be of eight years duration.
The growth was situated a little to the right of the median line
of the vertex ; it is about the size of the palm of the hand ;
raised from one-half to three-fourths of an inch above the level
of the surrounding skin (scalp) ; has a fungoid ulcerated surface,
and the margins are tuberous and eroded. The growth, with the
whole thickness of the scalp (down to and including a small
portion of the pericranium) has beecn removed, and also a margin
of healthy-looking integument, about half an inch broad, around
its circumference; microscopically, the structure is typically
epitheliomatous ; the cylinders of epithelium are very large and
massive. Below this, there is a nuclear infiltration 01 the sub-
cutaneous structures, apparently, however, not reaching the
pericranium or basal portion of the excised mass. I rom a native
male (Mahomedan), aged 40.

Presented by Professor K. McLeod.

224, Epithelioma of the tongue. From a Hindu male, aged 40.
The morbid growth is represented by an irregular-shaped ulcer,
about as large as a rupee (florin), situated on the dorsum and
left margin of the organ, near its base. The margins of the
ulcer are hard and eroded ; its surface deeply excavated, and also
covered with small, soft, nodular excrescences. The tongue was
removed by the ehain-ecraseur. The ulcer is seen to have been
bisected by the first application of this instrument, and a second
was therefore rendered necessary in order to include the whole ol
the morbid tissues. This seems to have been effectual, lor
microscopic examination of the posterior margin of the last
portion (base) of the tongue removed shows no cancerous infiltra-
tion -the muscular and other structures appearing quite healthy.

AW the characters of a true and rapidly developing epithelioma . are
observed in sections taken from the ulcer itself, ihc epitheha
proliferation extends downwards from the mucous membrane and
papilla? of the tongue into the subjacent muscuiar tissue, th
fibres of which, in the immediate vicinity of the morbid gio >
aie found broken down and infiltrated with small round cells and

SEEIES XVII.]

EPITHELIOMA.

593

nuclei. In the superficial strata, and at the margins of the
ulcer, the epithelial elements are very abundant, nucleated, hctero-
morphous, exhibit numerous nests, and in all other respects
conform to the usual structure of cancer of this variety (epi-
thelioma).

Presented by Professor K. McLeod.

225. An epithcliomatous ulcer of the tongue. It is about the size
of a rupee (florin) ; has an irregularly rounded outline ; and is
situated on the right margin of the organ, about midway between
its base and apex. The edges of the ulcer are thickened, indu-
rated, hard, eroded. The surface is deeply excavated and sloughy.
The sublingual, right submaxillary, and right parotid glands, were
all enlarged, indurated and infiltrated.

The tongue was removed post mortem. The subject was a Hindu male
aged 34, who died in hospital from exhaustion and inanition!
On account of the extent of the morbid growth, and the implica-
tion of the neighbouring gland-structures, no operative interference
was considered advisable or likely to prolong life.

Sections from the margins and base of the ulcer reveal, under the microscope
a profusely luxuriant epithelial growth, forming solid prolongations into
the subjacent muscular tissue of the organ ; modification into nests or
globes; and all the other characters of true epithelial carcinoma. The
intermuscular connective . tissue is freely infiltrated with small, round,
germinal cells and nuclei, and large ramifying capillary vessels. The
muscular tissue is pale and atrophied-looking, but is almost entirely free
from fatty metamorphosis, and the transverse markings or strim are still
distinct.

226. Preparation showing an epithelial cancer of the right middle

finger of a native (Hindu) male, aged 30. “ Its duration is said

to have been five months.” The finger has been amputated at
the carpo-metacarpal articulation. The growth involves the skin
and subcutaneous tissues on the palmar and inner aspects of the
finger, but does not affect the phalangeal joints or the bones!
It takes the form of an oval ulcer, rather larger than a rupee
(florin), with eroded and thickened margins, and an irregularly
excavated surface. D J

The structure, microscopically, is. typically epitheliomatous. The cell
elements are ol large size, highly proliferative and fatty ; “ nests ”
&c., are abundant.

Presented by Professor D. O’C. Raye.

227. “ Portions of an epithelial cancer of the rectum, removed from a
native aged 50 years. It presents a somewhat condensed cauli-
flower appearance, and is soft in consistency.” (Ewart.)

The morbid growth chiefly surrounds the anus, affecting the skin and mucous
membrane of this part, but is also found to extend upwards into the rectum
and implicates the sphincter muscles and lining membrane. In the external
portion there are numerous “nests” and processes (tubules) of proliferating
epithelium (squamous or flattened) ; in the deeper strata, a diffuse nuclear

bow'd11 I” McC*)’ prollfcrafcion of llie columnar epithelium of the

Presented by Professor J. Fayrer.

594

TUBULAR EPITHELIOMA.

[SEEIES XVII.

228. Carcinoma of the colon. The preparation exhibits about six
inches of the colon, partly laid open, and occupied by a huge
fungating mass, which involves all the coats of the bowel, and
has here so contracted its calibre that a finger can only with
difficulty be forced along its channel.

Microscopic examination shows the structure to be that of cylindriform
or columnar epithelioma. The cell elements, — though much
altered by the long maceration of the specimen in spirit, — still
display a sufficiently distinct columnar (epithelial) type, have large
nuclei, and are highly granular. These fill the gland-tubules of
the mucous membrane (which are abnormally dilated and
distorted), and are found also occupying spaces in the submucous
connective tissue, which is opened or frayed out so as to form an
imperfect stroma. Large numbers of small round cells and
nuclei infiltrate the muscular coat (much ‘developed and nodulated
in outline), and even reach the peritoneal coat.

The growth on the internal aspect of the gut is deeply ulcerated, and a
scraping from here displays large mucoid and granular cells,
shred cylindrical epithelium, and fat. No history.

229. Carcinoma of the rectum, with recto-vaginal fistula. From a
native female, aged 28, who died in the obstetric wards of the
hospital. At a distance of about from the anus a large,
ragged, ulcerated patch may be observed, stretching right across
the bowel. Its margins are abrupt, thickened, and indurated.
Its base exposes the muscular coat, which is also much thickened,
and presents a semi-gangrenous condition. The upper margin of
the ulcer is deeply undermined, so that a finger can be passed
upwards and to the left, for about an inch, between it and the
peritoneal coat. A communication between the rectum and
and vagina exists at this spot, — two openings or perforations
being found in the posterior vaginal cul-de-sac, just behind the
corresponding lip of the os uteri. One of these readily admits
a crow-quill, the other the point of a probe. The uterus itself is
of normal size, and apparently perfectly healthy. The ovaries
are also healthy, but fixed to the sides of the uterus and adjacent
bowel by means of old and firm peritonitic adhesions.

The sigmoid flexure and descending colon arc enormously distended, —
measuring about eight inches in circumference. They were
found loaded with soft, clay-coloured, foecal matter. The mus-
cular coat in this portion of the bowel is greatly hypertrophied, —
not less than a quarter of an inch in diameter. There were no
cancerous deposits in any other part of the body.

Sections made through the whole thickness of the margins and base of the rectal
ulcer exhibit, under the microscope, a most luxuriant epithelial growth in
the submucous layer; in parts reaching the inner surface of the bowel, but
tending chiefly to' dip or extend into the deeper-lying structures— the
muscular and peritoneal coats. This epithelial growth proceeds principally
from the submucous closed gland follicles — solitary glands — here situated,
although the simple tubular glands also participate in or contribute
towards the same. The epithelial formation takes the shape of huge
masses or cylinders of closely-lying, very large, polynucleated cells ; some
distinctly columnar, others rounded or irregular in outline; the protoplasm

SERIES XVII.]

MELANOTIC CARCINOMA.

595

granular and fatty. Here and there, the submucous connective tissue
forms a kind of imperfect stroma between the epithelial developments.
'I'he rectal ulcer is therefore truly malignant in character, — a specimen of
glandular carcinoma or cylindriform epithelioma.

230. “ A very unique specimen of melanosis of the ball of the eye,

causing complete disorganization of the organ. The section is
now of a chocolate colour.” (Ewart.)

This is a melanotic enkcphalokl cancer. Examined microscopically, a typical
delicate connective tissue stroma, with polymorphous epithelial cells enclosed
in its meshes, is readily distinguished. The cells possess large nuclei, and
are thickly infiltrated with very dark granular pigment. (J. F. P. McC.)

231. Melanotic epithelioma, the size of a walnut, and forming a
flattened but fungoid-looking growth. It developed from the
skin of the heel “ of a native named Hanjee, who stated that
about two years ago the foot at this spot was penetrated by a
thorn. This was followed by inflammation and suppuration.
A swelling formed, and was incised by a barber, but only blood
came away. There was very little pain.” The growth is
surrounded by a groove of ulceration at its base. Superficially
is convex, and on section smooth, homogeneous, and of a jet
black colour. Under the microscope it consists chiefly of large,
polymorphous, nucleated, epithelial cells, freely infiltrated with
very dark granular pigment matter. Some soft imperfectly
formed connective tissue is also found, but no distinct stroma
structure. The subcutaneous tissues are sparingly infiltrated.

Presented ly Dr. Herbert Eaillie.

232. Melanotic carcinoma from the sole of the right foot of a native
named Manick, aged 40. The patient stated, on admission into
hospital, that about eighteen months ago he first noticed a few
small spots of discolouration in the skin of the sole, and a year
ago this was followed by a little wart ; since then the disease
has extended, and assumed a more tumour-like form. He
complained of little or no pain except that incidental to the
position of the growth and experienced in walking, but it bled
freely when bruised or hurt in any way.

The growth consists of a flattened tuber, an inch and a half in diameter,
and about an inch in thickness. Its margins and surface are
fissured and warty-looking ; and, as well as the entire substance
of the tumour, exhibit an intensely black colour, interspersed
with a few yellowish streaks.

Examined micrpscopically, the structure is characteristically epithelioma-
tous. Epithelial proliferation with “ nests ” and cylinders, &c.,
are particularly distinct in the superficial portions of the growth,*
the deeper being more compact, more intensely pigmented, and*
consisting chiefly of highly nucleated fibrous tissue, into which
epithelial protrusions descend at irregular intervals.

Several ribs from a case of diffuse melanosis,— an East Indian
male, aged 44,— showing nodulated, dark, sooty deposits scattered
diffusely throughout the osseous tissue. They vary in size from a
pea to a hen’s egg, and, on microscopic examination, their

233

506

MYO-FII3EOMA.

[series XVII.

structure is that of enhephaloid cancer , modified only by the
dense pigmentary infiltration of both cells and stroma.

On the right side of the thorax, the 1st, 2nd, 3rd, 4th, 8th, 9th, and 10th ribs
were all softened and infiltrated by these melanotic deposits, — the majority
near their sternal ends. On the left side, with the exception of the 1st
and 3rd, all the other ribs were similarly affected. On the right side 49,
on the left 44, such pigmented growths were enumerated. Besides which
there were melanotic cancerous deposits in the lungs, liver, kidneys, bones
of the upper extremity, and in other situations of the body.

( See further, “ Medical Post-mortem Records,” vol. I, 1873, p. 16.)

234. “ A number of fibrous tumours removed at tbe post-mortem
examination of a female wlio died in tbe Medical College Hospital.
Some of these are situated in tbe substance of tbe uterus, but
most of them are placed between tbe organ and tbe investing
peritoneum. They are composed of fibrous tissue, nuclei
and cells, and a few unstriped muscular fibrils.” (Ewart.)

Presented by Professor D. Stewart.

235. A large polypoid tumour removed from tbe uterus of a Euro-
pean woman. It bad developed from tbe upper wall of tbe
cervix, half an inch above tbe os. Tbe pedicle was half an inch
long, and about the thickness of one’s thumb. It was divided
by the wire-ecraseur. Tbe tumour filled tbe vagina. It is tbe
size of a pomegranate ; nodulated in outline ; firm and fibrous-
looking on section. Its structure, microscopically, is that of
a typical myoma.

Presented by Professor T. E. Charles.

236- Polypus uteri. A firm fibrous-looking tumour, tbe size of a
duck’s egg ; slightly lobulated ; and possessing a short pedicle,
tbe remains or root of which — as large as a four-anna piece —
can be seen at tbe base. No distinct capsule can be traced, but
tbe outer layers of tbe growth appear to be more condensed
than tbe central portions. On section a dense-white surface,
intersected by opaque shining fibrous filaments (which have a
concentric arrangement), is observed.

Under tbe microscope, tbe structure is found to consist of smooth
muscular tissue, — tbe nuclei of which become very distinct on
tbe addition of acetic acid, — bound or held together by firm
white, fibrous or connective tissue. Tbe tumour is a myo-
fibroma.

Presented by Professor T. E. Charles.

237- A “'fibroid tumour ” (myoma) removed from the fundus of an
inverted uterus.

It is about the size of two fists ; slightly lobulated ; extremely dense and
firm — cutting like cartilage ; and has a pinkish-white, fibrous-
looking appearance on section. Tbe fibrous bands have a con-
centric arrangement, and enclose a large mumber of dilated
arteries and veins, — the latter have wide open mouths, and
many are blocked by soft red coagula.

Under tbe microscope, the growth consists principally of smooth
(organic) muscular tissue, much of it in concentric fasciculi
arranged around capillary vessels. A considerable quantity of

SERIES XVII.]

MYOMA.

697

fibro-elastic tissue also exists, but the muscular elements clearly
predominate, and the tumour therefore is a true myoma.

Presented by Professor T. E. Charles.

238. Calcified myomata. “ Two fibrous tumours springing by narrow
pedicles, from the external surface of the fundus of the uterus.
One, on the left side, is oval, small (2 inches by If inch), and
consists of fibrous tissue concentrically disposed. The other, on the
right side, is oval, larger, measuring 3 inches by 2£ inches, and of
stony hardness from almost complete calcareous degeneration. So
abundant is this earthy deposit that the section now presented was
made with difficulty with the saw. Near the roots of the tumours
there, existed, in addition to fibrous, a considerable admixture of
unstriped muscular tissue. At this point their peduncles are
manifestly continuous with the external substance of the uterus.
Both growths are scantily supplied with blood-vessels. The
uterus is atrophied, its cavity almost entirely obliterated, and
the Fallopian tubes and ovaries mere streaks of fibrous tissue.”

Presented by Mr. Khettur Mohun Dutt.

239. Myoma of the uterus. The patient was “a native female who
died from metrorrhagia.” The cavity of the uterus is almost

nhhr^rat^rl nxr a lovrvn iv

(Ewart.)

The ovaries are of normal size.

598

MYOMA.

[SEEIES XVII.

The patient died from pyaemia associated with a large carbuncle on the
back of the neck. ( See further, “ Surgical, Post-mortem
Records,” vol. I, 1875, pp. 157-58.)

241. The uterus of a native woman, aged about GO, preserved to
illustrate the mode of development, and the appearance at a
very early stage, of the so-called “uterine fibroid,” i.e ., myoma.

The little tumour (about the size of a hazelnut) is seen developing
interstitially in the anterior wall, and has not yet encroached
upon the cavity of the organ, — is still purely parietal.

242. Section of a fibro-myonja developing in the fundus uteri. “ It

is globular ; covered internally by thickened mucous membrane,
and externally by an attenuated lamina of uterine tissue. It
has encroached considerably upon the cavity of the organ.
What remains of the same is exposed between two red glass
rods.” There are two smaller tumours of the

same kind springing , from the posterior part of the fundus.”
(Ewart.) The principal growth exhibits a mixed fibrous and
muscular structure, and is thickly infiltrated with calcareous
material.

Presented by Mr. Khetter Mohun Putt.

243. “ A polypoid tumour, weighing 31b 14-|ozs. Its greatest length
is 9 inches ; greatest width 5 inches ; circumference in the long
diameter 22% inches, in the short diameter 15 inches. Is of six
years’ growth, and was removed from the anterior lip of the
uterus of a native woman aged 30, the mother of two children.”
The polypus projected external to the vulva for about two
inches, and its surface here has acquired a thickened, leathery,
and almost integumentary, appearance. The rest of the tumour
filled the vagina. On section it presents a distinctly fibrous
appearance ; is firm and resistant to the feel ; of a dull whitish
colour generally, but in parts blotched or discoloured by blood,
and exhibiting a reddish or purplish tinge. The pedicle is very
short, and where separated by the chain- ecraseur (which was
used for this operation) leaves a scar not larger than an eight-
anna (shilling) piece. The growth is a myoma.

On microscopic examination, the fibro-muscular bundles (with large, bright, and
distinct nuclei) are seen arranged concentrically, or intersect each other
irregularly in all directions. They are held together by a varying
thickness of delicate connective tissue. The vascular supply does Dot
appear to be very abundant.

Presented by Professor T. E. Charles.

244. T he uterus of an East Indian female, aged GO, who died from
cholera, showing several interstitial myomata.

The organ is very curiously misshapen from the presence of these
growths, and its surface is markedly tuberous. One growth —
originally apparently interstitial, now completely fills the cavity
of the fundus, and, on section, presents an advanced calcified
condition. The os internum is obliterated ; the canal of the
cervix occupied by gelatinous mucoid secretion. A second
tumour, the A sizo.of, a,, qqdqut,. projects. upwards .and. to.the right

SEniES XVII.]

MYOMA.

500

from the fundus ; and two others, of somewhat smaller size,
stand out from the posterior wall. These smaller growths are
very firm and fibrous, but show no calcification,
microscopical examination, the structure of all the tumours is
typically myomatous. In the smaller ones, nucleated fibro-cells
(muscular) are very abundant; in the larger, less numerous, and
replaced by well-formed fibrous (connective) tissue fasciculi,

245.

which have a more or less concentric arrangement.

246.

A preparation showing (a) a calcified myoma the size of an
orange, springing from the external aspect of the left horn of
the fundus uteri. Its external surface is invested by peritoneum
continuous with that covering the uterus. Its structure is hard
and fibrous in character, but shows also extensive calcareous
deposit, (b) Within the uterine cavity, attached to the inner
surface of the fundus a small polypoid myoma, the size of a
hazelnut. (e) Projecting from the anterior surface of the
organ, a small, calcified, irregularly rounded myoma, the size of
a nutmeg, invested by the uterine peritoneum.

The uterus itself is elongated and narrow. “ From a subject in the
dissecting-room.”

A short and narrow-pcdicled myoma growing from the anterior
suiface of the uterus (into the pelvic cavity). The tumour is the
size of a walnut, smooth and rounded, "it is invested by peri-
toneum continuous with that covering the rest of the uterus.
On section it is found that a thickened fold of peritoneum is
now the only connection between the growth and the uterus, so
that it can be completely shelled out of the capsule thus formed
for it by the serous membrane. The cut surface is decidedly
fibrous ; the consistency very firm and hard ; and, microscopically,
the structure is that of true myoma. The interlacing bundles
ot nbro-muscular tissue are well developed, and their nuclei
distinct and characteristic. Taken from a native woman, a^ed
about 55, who died in hospital of pneumonia.

A polypoid myoma of the uterus removed by operation (wire-
ecraseur). The tumour is ovoid in shape; slightly lobulated at
one end, ulcerated at the other. On section firm, fibroid-
lookrng; of a _ pinkish-white colour (in the fresh state),
ine structure is characteristically myomatous. The dis-
position of the bundles of smooth muscular tissue is, for the
most part, concentric ; it is freely supplied with nuclei, - bceom-
mg very prominent on the addition of acetic acid. The connective
tissue is scanty, but the blood-vessels numerous and large, and
in parts developed into an almost cavernous system
-Presented by Professor T. E. Charles.

248. Uterus laid

247.

249.

, \ J °PGn to exhibit a small short-pedicled growth

(myoma) developing from the posterior wall of the fundus, and
filling this portion of the uterine cavity. Preserved to illustrate
an early stage in the development of many of these growths.
;/°ln a native female, aged 5U who died from morbus Brmhtii
Sections of two fibrous” myomatous) “tumours fn the
walls of the uterus. rI hey have undergone almost complete

600

NEUKOMA.

[SEBIES XVII.

calcareous degeneration. The uppermost one is about the size
of a pigeon’s egg, the inferior one is about as large as an
orange. There is a small growth at the side as large as a hazel-
nut and as hard as a stone. Each of these tumours is surround-
ed by a lamina of uterine structure. The remains of the cavity
of the organ is held apart by a glass rod.” (Ewart.)

No history.

250. A preparation showing a pedunculated or polypoid myoma of
the intestine. The growth is the size of a small orange, and is
seen to have developed from the outer aspect of the small
intestine, — a portion of which has been preserved. It is rounded
in outline ; smooth ; has a distinct capsule formed b}' an expan-
sion of the peritoneal coat of the bowel. On section it is firm
and fibroid-looking ; — the cut surface shows a concentric arrange-
ment of structure. The matrix is the muscular coat of the
bowel, with which the growth is directly continuous at its
attached portion, and is of homologous structure, i.e ., consists
of smooth muscular tissue in bands or fasciculi, which display
an annular disposition throughout the tumour, are held together
by a little delicate connective tissue, and permeated by small
blood-vessels. The peculiar nuclei of organic muscular tissue
are rendered very distinct in sections treated with dilute acetic
acid. In parts, a little fatty and mucoid degeneration of the
binding connective tissue is observed.

Presented by the Civil Surgeon of Kampore Beauleah.

251. A preparation illustrating bulbous enlargements of the nerve-
ends (neuromata) in an old amputation stump of the forearm.
The extremities of the median, radial, and ulnar nerves in the
stump are rounded and expanded so as to form tumour-like
swellings, each about the size of a small hazelnut. These are
composed of nerve fibrilke bound together by firm white fibrous
tissue, and encapsuled by the common neurilemma of the
nerve-trunk.

The bones of the forearm are rounded off, smooth, and covered by a
thick fibrous investment. The tendons of the flexor and
extensor muscles are atrophied, and all these structures are
matted together by very dense, firm, fibro-adipose tissue.

252. A tumour, the size of a chestnut, removed from the inner and
anterior aspect of the left orbit of a native child, aged about
three years. It was situated at the root of the nose, and over-
lapped by the inner halves of both eyelids. Ihe growth was con-
genital ; when first noticed, about the size of a pea ; has slowly
acquired its present dimensions. It was intimately connected
with the superjacent skin ; has no distinct capsule. At one end
of the basal portion a thickened nervous cord is seen,— probably
the left supra-orbital nerve,— which can be traced into the
tumour-tissue, and is lost there, apparently breaking up into its
ultimate nbrillse. On section, the little tumour has a glistening-
white, fibrous appearance, is very firm and tough, cutting with

difficulty,

■/

SEEIE9 XVllO

ANGIOMA.

601

Microscopic sections exhibit well-formed connective tissue, the fasciculi
of which are arranged more or less concentrically, enclosing
angular and stellate cells and nuclei. Intermingled with this
tissue are large bundles of nerve-fibre, possessing both the white
substance (of Schwann) and axis cylinder. Several considerable-
sized arteries are found distributed throughout the growth,
and, in parts, numerous capillaries filled with dark pigment-
matter.

The structure of the tumour is therefore complex, but the tissues which
form its bulk are nervous and connective, and these are so inti-
mately commingled that it is difficult, if not impossible, to state
which preponderates. It may be regarded as a congenital Jibro-
neuroma.

Presented by Professor W. J. Palmer.

253. “ Section of a vascular tumour as large as a walnut removed
from the upper and outer part of the left arm of a native of
Jessore. It had been growing three years. It had bled a great
deal at various times, and during the four da}rs prior to its
extirpation, it bled almost constantly, owing to the unskilful
application of a horse-hair ligature, which partially strangulated
the growth and opened some of the vessels. Only three
ligatures were used at the removal of the growth, which
consists of a rich network of vessels supported by fine delicate
fibro-areolar tissue ; and at those points where blood had become
extravasated, there exist a great number of blood corpuscles,
many fat globules, and a few exudation corpuscles.” (Ewart.)

Presented by Professor J. Fayrer.

254. “ A section of a pendulous fibro-vascular tumour removed from
the region of the left anterior superior spinous process of the
ilium of an old woman, aged sixty, residing at Colootollah. It
consists of an extremely fine network of areolar tissue and
minute vessels, the openings of which, and of the larger trunks
are plainly seen.” (Ewart.)

The tumour is as large as one’s fist. The skin over it has a remarkably papillated
appearance, and is seen to be thus disposed in vertical sections made for the
microscope. 1 he blood-vessels entering so largely into the composition
ot the grow tli seem to be developments from those normally supplying the
cut.s vera. They are throughout dilated, in parts almost cavernous in
character,— in fact, m one portion, a cyst-like cavity is found, filled with
granu ar pigmented debris of soft, cheesy consistency,— evidently altered
blood. This cyst is lined by a layer of flattened epithelium, and appears to
e t lerefore an unusually large dilatation of one or more vessels, which has
become gradually separated from the rest, and thus constitutes a closed
cavity (sanguineous cyst). A considerable quantity of abundantly nucleated
connective tissue exists between the plexuses of vessels, supporting and at
the same time separating them from each other. The tumour is un-
doubtedly a simple angioma. (J. p. p. McC.)

255. A small vascular tumour (angioma) removed
an East Indian boy, about 13 years of age.
congenital, but of late had increased rapidly,
connected with the superjacent skin, which has been removed

Tl L ;• bd0WVn is lmWdcd in subcutaneous

adipose tissue. There is no capsule, and no well-marked line of

from the thigh of
The growth was
It was intimately

602

CAVERNOUS ANGIOMA.

[SEEIES XVII.

demarcation. The structure is purely ncevoid — a simple group
of dilated capillary vessels, in which venous channels appear
to predominate. These are seen (under the microscope) to be
held together by a little delicate, nucleated connective tissue, and
a few elastic filaments.

Presented by Professor K. McLeod.

256. Cavernous angioma. A small rounded tumour, “ removed from
behind the left ear of a native.” It was highly vascular, and
thought to be malignant. .The superjacent skin is closely
connected to the growth, and has been excised with it. On
section, the structure is seen to be honeycombed, and consists
of a series of intercommunicating vascular spaces bound together
by fibrous tissue. Under the microscope, the vascular alveoli are
seen to be formed by fibro-elastic tissue, are lined by flattened
pavement epithelium, and contain a soft granular debris, in
which shrivelled and contorted blood-corpuscles are readily
distinguished.

Presented by Professor J. Fayrer.

257. Cavernous angioma of the left orbit. From a native male patient,
aged 65.

The growth was said to be of ten years’ duration. It is about the
size of a small orange, the surface slightly lobulated, the consist-
ency semi-elastic and soft.

The tumour on section exhibits throughout a highly vascular cavernous
structure, a condition which is verified on microscopic examin-
ation. The septa or walls of the vascular spaces are formed by
delicate fibro-elastic tissue ; the latter are lined by a layer of
hyaline flattened epithelium, and filled with blood-corpuscles in
various stages of disintegration.

Presentcdby Professor S. B. Partridge.

258. “ Aneurismal tumour by anastomosis occupying the situation of
the middle and ring fingers of the right hand. The arteries
and superficial veins are enormously enlarged. They are injected
with vermilion.” (Ewart.)

The ulnar artery chiefly contributes to the formation of the tumour, but, on the
dorsal aspect of the wrist and hand, there is a kind of cirsoid dilatation of
the branches of anastomosis between this vessel and a very largely developed
posterior radial artery, which seems to have come off from the brachial
directly, or from the radial proper near the bend of the elbow.
(J. F. P. McC.)

Presented by Professor J. Jackson.

259. Cirsoid dilatation of the coronary vessels of the stomach. In the

fresh state, the mucous membrane was found congested, and of
dark purplish colour. The inner surface is raised and corrugated ;
this, at the oesophageal end, being due to a very remarkably varicose,
dilated, and thrombosed condition of the coronary vessels in the
submucous tissue. There is no lesion of the mucous membrane.
From a European aged 49 (an indigo-planter), who died from
aneurism of the thoracic aorta. ( See further, “ Medical Post-

mortem Records,” vol. II, 1877, pp. 359-60.)

BEEIES XVII.]

SEBACEOUS CYSTS.

G03

260. “ Portion of the walls of a subcutaneous cyst with sebaceous
contents. The internal membrane is much pitted and corru-
gated.” (Ewart.)

261. Subcutaneous sebaceous cyst of globular shape, and as large as an
orange. It contains pultaceous fatty material, of the consistency
and colour of brown honey.

262. A similar cyst -wall, the contents having been evacuated. The
skin is adherent to the surface. The interior is shreddy and
laminated.

263. “Two globular subcutaneous cysts, each measuring about an
inch and a half across. To the uppermost one a portion of
integument is attached, the cutis vera of which is lying in
accurate apposition to the growth. The cystic wall is composed
of two distinct layers, viz., an external translucent lamina of
white fibrous tissue, and an internal , dull, leaden-coloured
lamina . The lower cyst is formed by a single layer of dense,
strong, fibrous tissue, enclosing a material of an opaque colour—
a mixture of fat and cholesterine and degenerated scales ”
(Ewart.)

They are both very characteristic sebaceous cysts.

264. “A well-defined subcutaneous” (sebaceous) “cyst filled with

fat and cholesterine, which are now solidified in the preparation ”
(Ewart.) 1

265. A cystic tumour, the size of a pigeon’s egg, “ removed from the
neck.” It consists of a series of small cysts separated by broad
bands of fibro-elastic tissue, and containing yellowish, cheesy-
like soft material, which, under the microscope, exhibits much
fat in granular and molecular form, and numerous degenerated
epithelial scales (multilocular sebaceous cyst).

266. A large sebaceous cyst with semi-solid, yellowish-white, curdy-
looking contents. It was “ removed from the neck, between the
origins of the sterno-cleido muscle of a native, aged 23 years
I he cyst is thin and well-defined, having a nucleated epithelial
lining, a basement membrane, and a strong protective layer of
connective tissue giving passage to a rich supply of blood-
vessels. Contents lardaccous, consisting of granules, fat, and
cholesterine, almost all soluble in ether under the field of the
microscope. The man made a slow recovery. A small opening
occurred in the trachea from subsequent ulceration, but this
eventually closed. (Ewart.)

Presented hy Professor J. Fayrer.

267. A subcutaneous sebaceous cyst, the size of a large orange
removed from the gluteal region of a native male patient!
Besides the oi dinary putty-like material “large quantities of
cholesterine were found in the cyst-contents.”

Prcseti ted hj Assistant Surgeon Ram Chunder Sen, Dacca.

268. An entire sebaceous cyst, the size of a small orange, removed
fiom the scalp of a native. Its contents consisted of the usual

cel sVheM? TteT-’ c,omposod principally Of fat and epithelial

f resell % ft. J " S° C°mp<mnd “ 8ranuk

604

MUCOID CYSTS*

[SEBIES XVU

269. A portion of a very thin-walled sebaceous cyst, which was as
large as a Tangerine orange, and was removed, 'post mortem , from
just beneath the skin of the left mammary region, two and a half
inches above the nipple.

From a native male patient, aged 40. The cyst was filled with
brownish, opaque, putty-like material.

270. A large sebaceous cyst removed from the right shoulder of a
Mahomedan, aged 45. It was intimately adherent to the super-
jacent skin, which had ulcerated at one spot (as large as a four-
anna piece), “ five days before the operation was performed.”
The growth is said to have been of three years’ duration.

The cyst-walls are thin, but composed of well-formed nucleated con-
nective or fibrous tissue. The lining membrane is shiny, pearly-
white, brilliant, consists of several layers of flattened epithelial cells
undergoing fatty metamorphosis. The contents are pulpy and
flaky, — like spermaceti, and, under the microscope, exhibit an
abundance of fatty and degenerate epithelial scales, free fat —
globular and granular, and much cholesterine, in the form of
flattened superimposed plates.

Presented by Professor K. McLeod.

271. A small cystic growth (the size of a sparrow’s egg) with very
thin, transparent walls, “removed from the mouth — probably

a rcinula.

272. A subcutaneous mucoid cyst removed from “ the shoulder of a
native female. It was found filled with dark, coffee-coloured
fluid, of thin, glue-like consistence.”

The cyst is multiloculated ; the walls are composed of delicate connect-
ive tissue lined by epithelium, and contain now a soft mucoid
material, in which are suspended numerous cell-elements, — epithe-
lial, and of the character of mucus-corpuscles. Individual
loculi vary in size from that of a barley-grain to that of a hazel-
nut. A portion of the integument is adherent to one side of
the growth.

Presented by Professor J. Fayrer.

273. A tumour of the thyroid gland, removed by operation from a
Mahomedan, aged about 29. It is said to have been of eight
years’ duration, and to have been accompanied by a good deal
of throbbing pain.

“ The tumour oocupied a space extending from the prominence of the
larynx to the notch of the sternum, and had on either side the
sterno-mastoid muscles widely separated. Was freely movable in
all directions, and not adherent to the skin.”

The growth consists of an oval-shaped enlargement of the entire gland,
constituting a mass rather larger than one’s fist. It is surrounded
by loose connective tissue containing several large blood-vessels,
which all required to be ligatured. Beneath this is the true
fibrous capsule of the thyroid, sending innumerable dissepiments
into the interior of the gland, so as to subdivide it into various
sized lobules, and these, in turn, are made up of a multitude of
small cysts ; — some as largo as a pea, the majority smaller, and
and a great many quite microscopic. These cysts arc occupied by

SECIES XVII.]

SEROUS CYSTS.

605

a gelatinous, rosy, or pale-yellow material, and exhibit, under
the microscope, a delicate cyst-wall of lino connective tissue,
lined by flattened nucleated epithelium, and filled by variously-
coloured mucoid or colloid secretion. The larger cysts seem to
be formed by the coalescence of two or more of the smaller ones.
Upon the dissepiments large-sized but thin-walled vessels ramify,
but do not penetrate the cyst-contents. Towards the centre of
the growth the fibrous septa are much thickened, and rigid
from calcification.

There is thus no abnormal growth, but an exaggerated condition of
the normal structure of the thyroid, and. with it a more com-
plex and abundant vascular development. Many of the septa
are also infiltrated with mucoid material, and no doubt to the
softening thus produced must be attributed the development of
the smaller into larger cysts, and the general very succulent and
gelatinous consistency of the entire "mass.

Presented by Professor K. McLeod.

274. “ Encysted tumour, with serous contents, pressing upon the
carotid sheath near the bifurcation of the common carotid artery.
The growth simulated aneurism. It occurred in a very old man,
who died shortly after his admission into the Medical College
Hospital.” (Ewart )

Presented by Professor J. Fayrer.

275. “ A large bursa from the front of the patella. It contained
thickened synovial fluid. Its walls are cartilaginous in consist-
ency and fully a quarter of an inch in diameter.” (Ewart.)

Presented by Professor S. B. Partridge.

276. Hydrocele of the left tunica vaginalis. This membrane has
been artificially dried after evacuation of its contents (sixteen
ounces of serous fluid). The pyriform outline of the cyst and
the structure of its wall are well demonstrated.

Removed, post mortem , from a native male, aged 35, who died of pul-
monary phthisis.

277. A specimen of congenital cystic degeneration of the kidneys.

“ I rom a native female child, aged three months, apparently in
perfect health, who died from asphyxia (over-lying), the result
of accidental smothering in the bed-clothes during sleep.”

Both organs are enlarged to about three times their normal size, and
are remarkably lobulated, the lobules being formed by multi-
locular or compound cysts. These vary in size from that of a
small pea to that of a pigeon’s egg, and are made up of a series
of secondary, quite minute, cysts. All contain thin, limpid,
serous fluid. The proper secreting structure is almost entirely
replaced by this very remarkable cystic transformation.

Presented by J. R. Wallace, Esq., l.e.c.s., Edin.

278. A bursal cyst found, postmortem , in the sole of the left foot

situated immediately beneath the skin,— between it and the
short flexor tendons. The cyst-wall is complete, and has a shiny
glistening lining membrane. It contained a little Yellowish
slightly turbid serum. '

• From a native male, aged 22, who died of dysentery.

606

SANGUINEOUS CYSTS.

[series XVII.

279. A sanguineous cyst of the right testicle, situated at its upper
part, and apparently due to rupture of the vessels composing the
globus major of the epididymis. The cyst-wall is very hard and
firm from calcareous infiltration. Kemoved, post mortem, from
a native male, aged 60.

280. A cystic ha3matoma, partially calcified. From the left supra-
scapular region (beneath the trapezius muscle) of a Punjabi
(male), aged 30. The exact duration of the growth could not be
ascertained. It was punctured prior to removal, and about an ounce
of fluid blood evacuated. The growth is the size of a small orange,
cystic in character, and filled with blood — partly coagulated.
Some muscular shreds of the trapezius are closely adherent to the
cyst-wall. The latter is composed of well-formed, tough, fibro-
elastic tissue, two to three lines in thickness. On incision, the
remains of a few imperfect septa or dissepiments are observed.
The contents, examined microscopically, consist of altered
blood only ; no abnormal cell growth. Several calcareous con-
cretions (one rather larger than a pea) are found projecting into
the cyst-cavity from its wall at one part ; and the fibro-elastic
tissue of the latter is itself seen to be undergoing calcareous
transformation. No blood-vessel of any size can be traced into
or near the cyst. The blood extravasation has, probably, been
accidental, and the cyst-wall now formed around it lias served to
isolate and separate it from the surrounding muscular and other
tissues.

281. Hypertrophy with cystic degeneration of the thyroid gland. The
cysts vary in size from that of a pin’s head to that of a pea,
and are filled with thick, yellow, colloid material.

From a native female, aged 20, who died in hospital from (idiopathic)
tetanus.

282. Colloid cysts of the left kidney. From an East Indian (male)
aged 30, who died of acute pulmonary tuberculosis.

The organ is much enlarged, weighing 9£ ozs. From its surface project
numerous large cysts filled with brownish-yellow, sticky material
— like glue (colloid). They extend deeply into the secreting struc-
ture, which is coarse-looking, but otherwise apparently healthy.

283. Left kidney infiltrated with colloid cysts. These are solitary or
in groups, and vary in size from that of a pea to that of a small
hazelnut. The material they contain is brownish, gummy,
semi-transparent. The right kidney contained none of these cysts.

From a native male, aged 30, who died in hospital of pneumonia.

284. “ A large multilocular ovarian tumour. It consists of several
small cysts, varying from the size of a hazelnut to that of an
orange. One of the parent cysts is as large as a man’s head.
The walls are very thick, dense, and strong.” (Ewart.)

285. A very large compound or mutiloeular ovarian cyst. The
largest or mother-cyst is the size of a water-melon. It contains
several smaller ones, with thick dissepiments between them.
No history.

286. A large ovarian tumour (cyst). The walls are very dense and
thick ; and while one portion of the same exhibits a comparatively

SEEIES XVII. ]

MULTILOCULAR CYSTS.

C07

smooth inner surface, the rest is covered with nests of proliferat-
ing, semi-solid, cystic growths.

287. “ A large cystic tumour containing gelatinous matter, removed

from the front of the ear of a native. It weighed lOlbs 7 ozs.,
and was attached by a long pedicle to the skin just in front of
the ear, reaching to his waist. It had no deep-seated connec-
tions. The tumour had been growing for the last five years, and
the man thought it was caused by slight hurt from a bamboo.”

The cystic tumour is the size of a water-melon. Its external surface is
covered by the skin, which presents a normal but somewhat pie-
bald appearance ; the latter being due t° long maceration in
spirit, and consequent separation, in patches, of the pigmented
cuticular layer. Beneath the skin, and inseparably connected
with it, is the proper cyst-wall, from half an inch to an inch in
thickness, and composed of fibro-elastic tissue. (It consists,
under the microscope, of dense white fibrous tissue, abundantly
nucleated, and containing a large number of capillary vessels.)
From the sides of this cyst-wall septa seem to have developed,
dividing its interior into numerous compartments of varying
size (multilocular). The remains of these, in a tattered, disor-
ganised, and broken down condition, can still be identified. No
fluid contents are now found. The growth seems to have been
fibro-cystic in character, and, in the fresh state, was probably
much infiltrated with mucoid material.

Presented by Dr. Mathew, Civil Surgeon Darjeeling.

288. Preparation showing a small multilocular cyst involving almost
the _ whole of the left ovary. Its contents consist of soft, curdy
semi-solid material, which, under the microscope, exhibits no
definite cell-elements, but is composed of fatty granules and
molecules, with free nuclei, and withered and degenerate
( r epithelial) cells.

Presented by Professor C. 0. Woodford.

289. A multiloculated ovarian cyst removed by operation from a
native female, aged 34<.

"She was a married woman, the mother of two children,-the last born eight years
f?* Ihe duration of the growth was two and a half years. The oper-
ation consisted of one incision five inches long, in the median line from the
umb, .cns downwards. Adhesions were found the ALl

intestines, broad ligament, and uterus. These were separated ; the cyst
drawn out and tapped; the pedicle divided, ligatured, and returned into the
nbdo„„„„, cavity. The patient survived the operation only two hours
Her general state of health was unsatisfactory.”

The parent-cyst has strong fibroid walls. Attached to its interior are
more than a dozen sessile secondary cysts. These, on puncture
exude a thick, opalescent, mucilaginous fluid, and their walls’
are found studded with smaller tertiary -cysts. Some of the
l.ittei have also thick mucilaginous contents, others are more
solid and, when incised, exhibit a series of closelv racked

Thegfl^l’CySt1S’ • UP°n Gach- °tber Uke the P^ of a bud
Ihe fluid, under the microscope, is highly granular, and holds

608

PROLIFEROUS CYSTS.

[series XVII.

in suspension a multitude of rounded epithelial cells, all thickly
infiltrated with molecules of highly refractive mucoid material.

Presented Inj Professor T. E. Charles.

290- A cystic ovarian tumour removed by operation from a native
woman, aged 35. It had been growing for about eighteen
months. “ The two larger cysts were tapped during the oper-
ation.” The patient made a good recovery. The growth is seen
to be multilocular in character, the loculi in some instances
being separate and distinct, but the majority intercommunicate.

The two largest are exposed to show their compound character, and
the remains of the fibrous dissepiments upon their walls, indi-
cative of the coalescence of several originally distinct cysts.

The contents of the smaller cysts, which remain entire, consist of a
mucilaginous, blood-tinged fluid, of the consistency of white-
of-egg. The walls are thick, leathery, and fibrous ; their inner
surfaces smooth, shiny from an epithelial investment, and
exhibit considerable vascularity.

Presented by Professor H. Cayley.

291. An enormous proliferous cyst of the ovary having thick plicated
walls, about a quarter of an inch in diamater. From its interior
spring a series of secondary solid or semi-solid growths,
containing hair and much sebaceous material. No history.

292. “A very excellent specimen, exhibiting the early appearance and
connections of dermoid ovarian growths. Two cysts, as large as
hen’s eggs, spring from the right ovary. These contain hair and
a soft cheesy substance consisting of oil-globules and epithelial
scales. The dense fibrous character of the parieties of the
growth now distended with this material is well demonstrated.
The floor of that which has been almost emptied of its contents
is formed by this hairy and fatty matter. The section shows
that the remainder of the ovary is honeycombed by primative
cysts varying from the size of a pin’s head to that of a bean.
From the upper surface of the left ovary several small cysts are
seen springing, resembling nothing so much as a cluster of
Cabool grapes.” (Ewart.)

Presented by Mr. Vanderstratten.

293. A very large dentigerous or dermoid cyst of the ovary. It is
multiloeulated, and more or less solid in character. The loculi
arc occupied by thick, brownish, putty-like, sebaceous material,
and several contain, in addition, hair and teeth.

• “ Before the operation the tumour measured 19 inches in a vertical, and 20 in a
transverse direction, and the woman’s abdomen measured 43 inches in
circumference. After removal, when emptied of most of its thick fluid
contents, the cyst weighed ]91bs 4?ozs.” * *. * .* *.

“ The growth was first noticed three years previously, hut it remained stationary
^ ^ till within the last ten months, during which period it assumed the present
dimensions. The woman was twenty-seven years of age. She S;inku sixteen
hours after the operation.”

Presented by Professor T. E. Charles.

294. A preparation showing a large dentigerous cyst situated between
the anterior abdominal wall and the fundus uteri. A portion

SRRIKS xvri.]

DENTIGEROUS CYSTS.

COO

of the abdominal wall is preserved together with the cyst, the
uterus, and ovaries, &c. About an inch below and to the right
oi the umbilicus is an irregularly rounded opening with sloughy
edges, about two inches in diameter. It communicates with "the
cyst, and through it, during life, sebaceous material, hairs, teeth,
&c., were discharged. The cyst itself is as large as the foetal
head. It is firmly adherent to the parietal peritoneum all round
the opening in the abdominal wall ; posteriorly and below, it is
attached by a broad flat pedicle (an inch in length and’ three-
fourths of an inch in thickness) to the upper border of the fundus
uteri, a little to the right of the median line, and at the angle of
junction of the right Eallopian tube with the uterus. Between
these attachments it is free. Its walls are thick and fibrous ; its
interior traversed by shreddy dissepiments of fibro-elastic tissue,
which seem to start from a common centre on the posterior wall’
and diverge towards the circumference. The inner surface is’
studded . with soft nodules and partially organised solid growths
fibroid in character. These are overlaid by soft, brownish
sebaceous or grumous material, imbedded in which are fine lon<^
hairs. The two layers of peritoneum forming the right broad
ligament, after investing the Fallopian tube, pass on to be reflected
over the outer surface of the cyst. The uterus is small and

unimpregnated j its cavity healthy. The overies are small and
atrophied.

The patient, a Bengali female, a widow, aged 20, stated that six months prior to her
admission into hospital she first noticed a swelling, the size of a walnut in
the hypogastric region, a little to the right of the median line. It slowly and
painlessly increased to the size of an orange, and was movable. Within
the last two months only has it grown more rapidly, and become painful
Twelve days ago a small slough formed upon the abdominal wall im-
mediatetely over the tumour, the skin gave way, and a thin purulent
discharge has since continued to exude.

She was not pregnant at the time of the first appearance of the growth, and since
then, with the exception of the last two months, has menstruated regularly
Latterly there Iras been a good deal of febrile disturbance b

On admission, the tumour presented a somewhat pyramidal shape,’ filled the hvno.
gastric region, the umbilical, and portions of the right and left inguinal

spaces. The sloughy opening in the abdominal parieties was enlarged, and
poultices applied, while the cavity of the cyst was daily washed out with
carbolic acid lotion Much grumous and sebaceous matter, besides hairs a

tew teeth, and small pieces of cartilage and bone, were thus evacuated • but
the prolonged irritation and discharge told upon her health, and she died
exhausted, after about a month’s treatment in hospital.

295. A large ovarian cystic tumour removed by operation from a native
lemale, aged 37.

The duration of the growth was three and a half years; the patient a married
woman; the number of pregnancies two,— the last child born seventeen
years ago. Menstruation regular until appearance of the tumour tl J '
frequent— every fortnight. Genera, healt’h at

good. Ihe latter was performed by one vertical incision cxion/i- r ^
just above the umbilicus to within two inches of the pubes ’ ‘ Ovs^/Ti"1
tumour then tapped one after the other , tumour separK from *hc

adhesions and brought out of the abdominal cavity. Iha i'le Sc“„reT w'i't’f
two catgut ligatures, returned within the abdomen, and eight sU«r.wh-o

610

CONGENITAL CYSTS.

[8ERIES XVII.

sutures closed the parietal wound. The patient died, on the eighth
day, from pelvic peritonitis, and probably haemorrhage from the divided
pedicle. No •post-mortem examination.

This is a compound proliferous cyst. The principal or mother-cyst is
the size of a melon, and has a thick strong wall of white fibrous
tissue. Its inner surface is smooth and glistening, — is invested
by a thin layer of epithelium. Within the mother-cyst are
secondary and tertiary cyst-formations, of all sizes, and either
sessile or pedunculated. The majority have mucoid fluid con-
tents. There are also firmer, nodulated, semi-solid growths,
which, on section and microscopic examination, present an acinous-
like structure, consisting of a basement membrane of connective
tissue lined on both sides by cylindriform epithelium. They
represent, apparently, the earlier stages in the development of
the truly cystic formations. Buds or villous processes project
from the inner surface of the basement membrane, form dendri-
tic vegetations, which meet at points to constitute closed acini
or embryonic (young) cysts. These latter are occupied by
mucoid material, in which lie suspended shred epithelial elements
— showing fatty and mucoid degeneration, and free, glistening,
yellowish, pigmentary particles, — probably altered blood.

Presented by Professor T. E. Charles.

296. “ A congenital cystic tumour removed from the occipital region
of a native child four months old. At birth the tumour was the
size of a hen’s egg. It has gradually increased, and also become
pedunculated, so that it hung down to the lower part of the
neck at the time of the operation. Six days after the removal
the child became tetanic, and died on the eighth day.” (Ewart.)

Presented by Professor J. Fayrer.

297. A sebaceous cyst, said to be congenital, removed from the thigh
of a native female, aged 30. It is the size of a large orange,
and contained thick, creamy, opaque-white, pultaceous fluid,
which, examined microscopically, consisted principally of large
polymorphous, mostly withered and degenerate, epithelial cells,
cholesterine crystals — in the form of superimposed brilliant plates
or scales, and much free granular and molecular fat.

Presented by Professor D. O’C. Raye.

298. “ A melanotic tumour from the lip of a cow. It is eight inches
long, seven broad, and four inches thick. Its section is of a
jet black colour.” (Ewart.)

Microscopically examined, the structure of the growth consists of succulent, soft,
fibro-elastic tissue, with nuclei and cells impregnated by very dark
granular pigment. There is no specific arrangement of structure.
(J. F. P. McC.)

Presented by Dr. G. Daly.

299. “ A great number of melanotic growths attached to the pleura
costal is of the horse. The convexities of the tumours are of
deep black colour, whilst some of the sulci are white or opaque.

SEMES XVII.]

BONY CYST IN A BULLOCK.

611

Many similar growths were found underneath the skin.”
(Ewart.)

Under the microscope, an imperfectly developed stroma of connective tissue, form-
ing alveolar spaces, is found, the latter enclosing rounded darkly pig-
mented cells and nuclei. The stroma is also a good deal pigmented. The
structure, therefore, has a resemblance to melanotic carcinoma in man.
(J. P. P. McC.)

Presented by G. Holmes, Esq., Veterinary Surgeon.

300. “ Large bony cyst developed in the symphysis of the lower jaw

of a bullock, and removed by making a flap of the lower lip,
and sawing through each half of the bone near their junction!
The under or buccal surface of the cyst is smooth ; the upper
or oral is rough and irregular, the laminae of the bone being
widely separated. At this spot an irregular opening presents in
front, from which the incisors projected, and of which some
portions have been preserved. The canals for the inferior
dental vessels, seen on the cut surfaces of the bone, are much
enlarged.”

“ Mr. Dickson has removed two precisely similar tumours from the
same position in other bullocks. One of these is now a useful
animal, and none the worse for the operation except being
unable to graze, and requiring therefore to have grass cut for
its use. (Colles.)

Presented by W. P. Dickson, Esq., Civil Surgeon, Rohtuk.

CATALOGUE

OF THE

PATHOLOGICAL MUSEUM.

MEDICAL COLLEGE, CALCUTTA.

IP-A-RT X.

MALFORMATIONS, MISPLACEMENTS, AND DIS-
EASES OF THE OVUM (CONGENITAL
MALFORMATIONS AND DEFORMITIES
GENERALLY).

ENTOZOA FROM VARIOUS PARTS OF THE
BODY.

CALCULI, CONCRETIONS, AND FOREIGN
BODIES FROM THE URINARY AND DIGES-
TIVE ORGANS, AND FROM OTHER PARTS
OF THE BODY.

Sekies XVIII, XIX, and XX.

8EBIES XVIII.]

INDEX.

015

Series XVIII.

MALFORMATIONS, MISPLACEMENTS, AND DIS-
EASES OF THE OVUM (CONGENITAL
MALFORMATIONS AND DEFORMITIES
GENERALLY).

INDEX TO THE SERIES.

1— Union of two nearly distinct foetuses, 1, 2, 3, 4, 5.

2*— TWO BODIES ATTACHED TO A SINGLE HEAD, 6, 7, 8.

3— TWO HEADS ATTACHED TO A SINGLE BODY, 9, 10.

4. — Acephalous and anencephalous, 11, 12, 13.

5. — Extremities increased in number, 14.

0— Extremities decreased, 15.

7. — Deformities of the fingers, 16, 17.

8. — Deformities of the foot, 18, 19, 20, 21.

9. — False or shapeless conception, 22.

10. — Extra-uterine fcetation, 23.

11. — Retention of ovum or fcetus in uterus after its death, 21, 25, 26

12. — Diseases of the postal membranes : —

(a) .— Apoplexy, 27, 28, 32, 33.

(b) . — Fatty degeneration, 25, 29, 46.

13. — Diseased early ova, 32, 33.

14. — Abortions and prematurely

EXPELLED FOSTUSES : —

1st month, 34, 35.

2nd

3rd

4th

5 th

6th

7th

8th

36, 37, 38, 39.

40, 41, 42.

43, 44, 45, 46, 47, 48.
49, 50, 51.
o2, 53, 54, 65.

56, 57, 58.

59, 60.

1-j.— Diseased full-term fostuses : — 9th ,, 61,62,63.

16.— Spontaneous evolution of full-term fostus, 64.

Battledore ” or fan-shaped placenta, 65.

18.— Cord with three umbilical veins, 66.

616

FCETAL MON STEOSITIES.

[SERIES XVIII.

19. — Hydrocephalus, 63, G7.

20. — Wormian bones, 68, 69.

21. — Lower maxilla showing development of teeth, 70.

22. — Congenital abnormity in fangs of teeth, 71, 72.

23. — Preparations from the lower animals illustrating —

(a) . — Redundancy of parts, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83,

84, 85.

(b) . — Deficiency of parts, 86, 87, 88, 89, 90, 91, 92, 93.

(e). — Mis- shape men t of parts, 92, 93, 94, 95, 96.

(d1). — Misplacement ,, ,, 97.

24. — Immature foetus (equine), 98.

1. Preparation of a monster which consists of “ two female children
united together in the thorax and upper part of the abdomen
by a broad connection, which extends from the sternum to the
umbilicus. Below and above these two points all is apparently
natural. The heads, necks, arms, lower abdomen, pelves, and
inferior extremities of both children are perfect, and the external
organs of generation complete. There is only one perfect
umbilical cord, but below that is seen a small prolongation, about
an inch in length, and three parts of an inch in diameter. This
prolongation is hollow, at the further extremity forming a cavity
about the size of a hazelnut, terminating in the nearer end in a
mass of cellular structure. It appears externally like a rudi-
mentary second cord, but its internal structure would almost
lead to the supposition that it was rather a monstrous umbilical
vesicle. The length of the whole monster is from 15 to 1G
inches ; circumference of the whole, 11 to 12 inches ; circum-
ference of the connecting medium, 9 to 10 inches ; length of
it, about 4 ; circumference of each head round the forehead
and vertex, 11 inches; weight, five pounds. There is a consider-
able quantity of hair upon the heads, and even upon the body
und extremities, and the finger and toe nails are perfect. In
fact, though rather small, it was evidently born at the full
period of utero-gestation.” ***

« There is one thoracic and one abdominal cavity common to both children, these
cavities being divided from each other by a single diaphragm. The walls
of the thorax are composed of a double set ol ribs, with two Btcrni, one
on the anterior and the other on the posterior part of the commissure,
so placed that each sternum is common to both children. There is con-
sequently a spinal column to each. The abdominal muscles are li icwise
double. ' The abdominal and pelvic viscera of both _ children are perfect
in all things, with the exception of the liver. This organ appears to
consist of two perfect livers united together at their convex surfaces-
There are two gall-bladders, one on each side of the centre, two hepatic
arteries, and two vena; portarum, with distinct cystic and hepatic ducts
for each side. Two umbilical veins pass down from the common navel,
and separating from each other they enfer the vcncD port® of each division.
Jn their course, these vessels immediately before reaching their destination
pass directly through the substance of the liver for about ail inch, anu

SEKIES XVIII.]

FCETAL MONSTEOSITIES.

617

emerging from thence enter the transverse sulcus. Each of these vessels
sends olf a ductus venosu3, which terminates in a separate vena cava.
There are four umbilical arteries, two for each child. This arrangement
of the liver of course reverses completely the disposition of the abdominal
viscera of the right child. The spleen is placed in the right hypochon-
drium, the pyloric extremity of the stomach looks towards the left side,
and the duodenum crosses the spine from left to right. All the other
abdominal and pelvic viscera are perfectly distinct on both sides. The
single diaphragm is perforated by a double set of the customary foramina.
* * * Indeed, the abdominal contents are so placed that their

arrangement may perhaps most readily be understood by conceiving the
viscera of one child reflected in a mirror to form the viscera of the other.”
(II. II. Goodeve). — Webb’s Pathologia Indica, No. 325, p. 292.

2. Tlie thoracic and abdominal viscera of the above monster. The

following interesting description of the former is recorded by
Dr. Goodeve : —

“ In the centre of the whole, floating in a capacious pericardium, is a huge heart
common to both children, yet in this, too, there is a partial attempt at the
formation of a double organ. Externally there is a slight sulcus running
down the centre, corresponding to an imperfect septum within. But in
the interior of the organ all is confusion and malformation. The right
ventricle on either side opens into a large auricular cavity common to
both, and situated at the upper part of the organ. The opening between
these cavities is furnished with a valve, also apparently common to both.
From the right ventricle of the left sido springs a pulmonary artery,
but from the corresponding ventricle of the right division no similar
vessel arises. The only opening into that cavity is through the auriculo-
ventricular foramen. The superior and inferior venae cavae of both sides
empty themselves into the common right auricle. This latter cavity again
communicates with a common left auricle by an enonnous foramen, which
may be supposed to represent the foramen ovale, but no trace of any
valvular arrangement to cover this gap can be discovered ; all is free,
and the passage of blood through it in either direction must have been
unimpeded. Into the left common auricle one pulmonary vein from each
child terminates. This left auricle communicates with two separate left
ventricles. Indeed, there is apparently one common opening between all
the cavities of the heart. From each of the left ventricles arises a perfect
aorta, one passing to the left in the natural course, the other curving to
the right to reach the spine of the right child. The semilunar valves of
each are perfect. They both give off coronary arteries, and from the
arches of either side spring art erne innominatse, carotids, and subclavians
The single pulmonary artery, viz., that of the left side, is distributed
exclusively to the lungs of the left child, and a well-formed ductus arteriosus
stretches between it and the aorta. The lungs of both children are perfect
and naturally formed. Those of each side are contained in a separate pleura!
A thymus gland common to both children is placed in the upper part of
the thoracic cavity. The absence of a direct pulmonary artery on the
right side is supplied by a branch which arises from the arch of the aorta
on its inferior side. In fact, this branch is apparently the ductus arteriosus
the commencement of the pulmonary artery being absent, or, perhaps*
more properly speaking, the aorta and the root of the pulmonary arterv
have coalesced in the progress of development, forming but one vessel as
far as the ductus arteriosus, the true pulmonary artery beginning from
thence.” a

Presented by Professor H. II. Goodeve.

3. “ Twins at the full term connected together in the umbilical region

in the manner of the Siamese twins. In all other respects the
children seem perfect.” (Ewart.)

Presented by Dr. Bedford.

018

FCETAL MONSTROSITIES.

[series XVIII.

4 “ Twins attached to each other in the umbilical region. One is a

full-grown foetus ; the other is diminutive in size, and the
subject of malformation about the head, face, neck, and extremi-
ties.” (Ewart.) The latter is attached to the abdomen of the
former, and is only about one-fifth the size of the mature foetus.
The upper extremities, in a rudimentary form, are alone develop-
ed. No history.

5. A monstrosity consisting of two female foetuses, apparently full-

grown and well developed, united together along the thorax,
but possessing (each) a separate abdominal cavity and upper
and lower extremities, &c. One of the conjoined twins may be
seen to have a hare-lip and cleft palate.

Presented by Honorary Surgeon J. Slane, Civil Medical Officer of
Goalparah.

6. A double monster, having a common head to two bodies, “ which

are joined together along the thorax and abdomen by their
anterior aspects.” (Ewart.)

7. “ A double monster with one face, one head, and two bodies.

Thorax and abdomen are joined together.” (Ewart.)

This preparation closely resembles the preceding, but an attempt at the
division of the head is more marked posteriorly, where a deep
vertical sulcus or fissure may be observed.

8. Twin foetal monstrosity. The bodies are separate and distinct

below the umbilicus, but above this point united anteriorly, so
that there is only one common thoracic cavity and head. The
upper and lower limbs of each foetus are well developed. Two
heads have, as it were, been fused into one. There are four ears,
but the facial organs (eyes, noses, mouths, lips) are all rudi-
mentary and very imperfect.

Presented by Hr. Cockburn, Civil Surgeon, Benares.

9. A bicephalous human foetus (monster) of the full term. Each

head is distinct and well formed ; the facial organs perfectly
developed. The body is single, and there is a single pair of
upper and lower limbs. No history.

10. A double-headed monstrosity (“still-born”). It consists of a

female (human) foetus, of about the full term, and well developed,
but possessing two heads. These arc separate and distinct,
and the features are perfectly formed. There is a double body,
but conjoined laterally from the shoulders downwards. Two arms,
two legs, a common thoracic and abdominal cavity with
duplicate viscera, except the genito-urinary ; the latter are single,
and there is also a single umbilical cord. The monster consists,
in fact, of two bodies compressed laterally, as it were, into one,
and supplied with two heads, two arms, and two lower extremi-
ties.

Presented by His Highness the Maharajah of Burdwan.

11. “ A foetus in which the convolutions of the brain are undeveloped,

and in which there is a spina bifida. There are scarcely any
frontal or parietal bones, the flat surface of the cranium being
situated on a plane about half an inch above the eyebrows and
the ears.” (Ewart.)

SEHIE8 XVIII.]

ANENCEPHALOUS FCETUS.

619

12 An anencephalous human fcetus. The spinal canal is closed.

Presented by Mr. Dutt.

13- “ An anencephalous foetus of the sixth month. To the right of the

umbilicus is a large opening in the abdominal wall, through
which nearly the whole of the small intestine, and a large portion
of the liver protrude. The whole liver is much distorted, but of
normal size ; the other viscera healthy. The chest and abdomen
have been opened by incisions leading from the abnormal aperture
in the anterior wall of the latter, and are indicated by a stitch
placed above and below the same.”

“ A large flaccid bag of integument protruded from the back of the
deformed head. On laying it open, it was found full of reddish-
grey pultaceous matter, which, under the microscope, showed
nerve tubules, with granules of fat and plates of cholesterine.
On cutting through this, the vertebral theca was laid open
from the occiput to the sacrum, there being no vertebral
arches. The theca contained a rudimentary ligamentum den-
ticulatum, but no trace of a spinal cord. The roots

of the nerves (see preparation) run through its cavity
upwards and forwards, and are lost on the anterior wall of the
theca, not terminating in free ends or loops. One of these roots
excised, showed distinct nerve fibres, mixed with white fibrous
tissue.”

“ The vaul.t °f the skull is within one-tenth of an inch of its floor. Its
cavity, besides dura mater, contained two pulpy, bilobed masses,
(ludimentary optic thalami and corpora striata). No traces of
cranial nerves were distinguishable.” (Colles.)

Presented by Professor T. E. Charles.

14. Poitions of both feet of a native woman aged 35 (who died from
dysentery, &c.), showing supernumerary great toes. The first
and second proper toes are also conjoined or webbed, though
distinct as regards their osseous and ligamentous structures.

1 he supernumerary as well as proper great toe in each foot has two
phalanges The latter (proper toe) articulates with the rounded
head of the first metatarsal bone; the latter (supernumerary toe)
articulates also with the inner side of the head of the same
metatarsal, which is here flattened to form a smooth articular
surface, and .is provided with a separate synovial membrane,
ihe anatomical conditions represented, suggest the probable
development of the supernumerary member from one of the so-
called sesamoid bones usually found in this situation.

A human fcetus at. the full term of utero-gestation, but in which
the lower extremities are quite undeveloped and wanting. The
body ends in a curious conical fleshy mass, in which, on dissection
two or three rudimentary bones are discovered, and much fatty
hbro-muscular tissue. At the end of the spine, posteriorly is a
distinct caudal appendage or tail, an inch in length, and nearly
hall an inch in thickness at its base. J

16.

'pfS‘”0P(Collc?)Umb (“° di3eaSC)' An,Putatotl at request of

620

MALFORMATIONS OF HAND AND FOOT, [seeies xviii.

The metacarpal bone and both phalanges are about equally and propor-
tionately hypertrophied. The metacarpo-phalangeal and inter-
phalangeal joints are healthy.

The tendon of the extensor longus pollicis is of extraordinary length and
thickness.

Presented by Dr. Herbert Baillie.

17. Congenital malformation of the index and middle fingers of the

right hand. From a native male, aged 30, who died of disease
of the spine, &c. The great thickening of the fingers is seen
on dissection, to be associated with abnormal development (elong-
ation) of the proximal phalanges chiefly. The articulations
between these and the carpus are distinct and separate,
and from this point they diverge like the legs of the letter Y.
The first and second phalangeal joints are ankylosed.

18. Talipes varus (congenital). From a native child. A very good

illustration of this deformity.

Presented by Dr. Edward Goodeve.

19. “ Congenital talipes varus, with chronic ulceration of the soft parts

on the outer side of the foot, and sinuses running up along the
tendons into the leg. From a European.” (Colies.)

Presented by Professor J. Fayrer.

20. Left foot, showing (congenital) arrested development of the toes.
The three outer toes are represented by wart-like fleshy promi-
nences only, and the two inner are stunted and knobby ; consist of
a single bony phalanx, and bear no nails.

Taken from a uative male (Makomedan), aged 10, who died in hospital
from accute pericarditis, &c.

21. Hypertrophied toe. No marked morbid change can be detected

in this specimen except an overgrowth of the subcutaneous
adipose tissue. The skin itself is not abnormally thickened.
The bony phalanges are somewhat small, but the osseous tissue is
healthy, and.— as probably belonging to a child, — is still tipped
with cartilage, i.e., incompletely ossified. The inter-plialangeal
joints are healthy. The terminal phalanx is semi-flexed on the
middle one. The toe has been removed entire, but there is ^ no
trace of the metatarso-phalangeal articulation ; it may therefore
have been an accessory or redundant member. No history
received.

Presented by Dr. Goldsmith of Sutna, Surgeon to the Baglielcund
Agency.

22. Female foetus with an aborted twin development. From an East

Indian female, aged 23, — her fourth pregnancy.

“ Labour set in naturally after seven months of gestation. There was dropsy of the
amnion, from which about two gallons of fluid escaped during parturition.
The first and second pregnancies were natural, the third terminated in
abortion at the second month. The patient suffered from puerperal mama
after her second pregnancy.”

The complete foetus is healthy, and well developed for the period at
which it was expelled. The internal organs have all been
examined and found normal. But, at the posterior aspect of the

beeies XVIII.] FALSE OR SHAPELESS CONCEPTION.

621

coccyx, is attached, by a firm fibrous or ligamentous band, the
blighted remains of another foetus.

These consist of a scries of small and largo globular, cjst-like masses, grouped
together in bunches, and, in the fresh state, verj similar in appearance to
a “ hydatid chorion ” or “ hydatid mole.” On dissection, a few of these
contained simply serous or sero-sanguinolent fluid ; others, some sabulous
or sebaceous-looking matter ; and the majority, a soft, brain-like, pulpy
material, which, examined microscopically, consists almost entirely of
small, round, granular cells (indifferent germ cells), imbedded in a faintly
granular basis-substance ,- and, in parts, the existence of delicate loopod
capillary vessels is detected.

Besides the cyst-like bodies, there are numerous cuticular tumours, i.e., little
growths of cellulo-adipose tissue, solid and firm, and invested by well-
developed normal skin (with hairs, and glands, &c.). The largest fleshy
mass (at the summit of the foetal remains, — see preparation) is about the
size of an ordinary foetal head at full term ; has a firm, laminated, fibrous
capsule ; and is filled with pulpy material like that above described,
amidst which, fragments of striped muscular fibre are discovered. Below
this, there is an irregular mass of osseous tissue, which is capable of
being recognised (by certain indistinct homologies) as probably represent-
ing the imperfectly developed vertebral column and pelvis of the blighted
ovum. For, commencing at the fibrous medium between it and the healthy
foetus, there is found a bony growth somewhat resembling a portion of the
os innominatum, — the rami of the pubes and ischium, and the tuberosity
of the latter being faintly recognisable ; and, a foramen left between the
rami and tuberosity, represents, perhaps, the acetabulum, while, a smooth
shallow concave surface of bone above this, would indicate a rudimentary
iliac fossa. To one of the rami is attached the rudimentary penis and
scrotum, seen at the lower part of the preparation. The outline of the
_ former is fairly marked, and its canal pervious for a short distance.

1 he irregular nodules of bone which succeed (lie above) the rudimentary pelvis
just sketched, are very varied in shape and size. Some seem undoubtedly
to represent a rudimentary spine (vertebra)) ; others are like the
jaws, i.e., of crescentic shape and pitted (alveolated). Bounded and
irregular little masses of bone are also found in the interior of some of
the “ hydatidiform ” cysts.

The placenta is single. Its structure, and that of the cord (also single), appears
to be healthy. 1

From all the above it may be concluded (n) that a twin conception bad
taken place ; (4) that one ovum has progressed in normal
development up to the period of its premature expulsion ; ( c )
that the other has, at an early period, — (but not very early, since
so much osseous tissue exists, and even a rudimentary penis), —
undergone a kind of hydatidiform degeneration ; (d) "that from
an early period both foetuses were united dos-d-dos by means of
the narrow ligamentous band described above ; and (e) that the
diseased condition ol the one, led to the premature expulsion of
both.

Presented by Mr. Chambers, l.m.s., Calcutta.

23. Extra-uterine foetation. Fragments of bone, belonging, probably,
to a decomposed foetus, and removed from an umbilical fistula
in the abdominal wall of a native woman (Hurridassi), a^ed
about 20. J °

“About two years ago she became pregnant for the second time.
During the fifth month of gestation a ‘ red discharge ’ came on,

622

MISSED ABORTIONS.

[series XVIII.

-•

and continued for three months, the abdomen coincidently
getting smaller. As the discharge lessened, an umbilical abscess
formed, and eventuated in a fistula. Through the latter, bits of bone
began to be extruded. There was slight fulness of the anterior
vaginal wall, which, on being pressed, caused an oozing of pus
through the umbilicus. The uterine sound could not be passed
beyond the os internum, but entered easily for four and a half
inches through the umbilicus into a sac or pouch-like cavity,
from which, by means of a small polypus-forceps, the majority
of the bits of bone (preserved) were removed.”

Presented by Professor T. E. Charles.

24. A human female foetus, expelled dead at the full term of pregnancy.

The foetus is believed to have died in utero, at about the fifth
month of gestation, at which period, it is said, the mother (a native
female, aged 17, primapara) sustained a fall upon the abdomen.
The movements of the child ceased after the accident, but no
other local disorder or any constitutional disturbance took place,
until towards the end of the ninth month. She now had a severe
attack of fever, attended with “fits of a tetanic nature,” and
was delivered of this dead foetus.

Presented by Babu Kailas Chundra Mookerjee, M.B., Chinsurali.

25. Foetus and placenta of about the sixth month, from a case of

“ missed abortion.” The patient was delivered at the full term.
The foetus is a female, and exhibits much intra-uterine maceration,
with shrivelling and shrinking of the body and limbs, —a withered
and attenuated appearance. It weighs . 16ozs., and measures
Id inches in length. The placenta is thickened but soft, and is
undergoing fatty degeneration. It weighs 10 ozs. The length
of the funis is 17 inches. No history.

Presented by Professor R. Harvey. .

26. A similar case of “missed abortion, in which the foetus was

retained in utero for two months after its death. The preparation
shows a foetus of about the fifth month, very much shrivelled,
and the skin sodden-looking, but otherwise perfect. The placenta
is comparatively small. The maternal surface presents a soft y
lobulated appearance, and jelly-like consistency. It is very dark
in patches (not uniformly) from blood extravasation (“ apoplexy ).

The greater part seems to have undergone a kind of gelatinous degener-
ation. Under the microscope, the placental capillaries are
found much shrunken, and either occluded by very dark, opaque,
granular material, — probably altered blood, or are empty and
present attenuated and atrophied (hyaline) 'walls. The non-
vascular tissue consists of round or oval cells and nuclei ; the
former largely charged with fat-globules or glistening molecules
of mucoid material ; in some places contain yellowish-red
pigment-granules,— apparently from blood-imbibition.

“ History. — Victoria Mitchell, an East Indian married woman, aged 35 years
® ias admitted into hospital on the 14th September 1881. She hwtai
eleven conceptions, of which eight have proved abortive. lim piesen
pregnancy dates from about the 10th January 1881— her last
She quickened about tlio middle of June, at which period the foetal heart

sebies xviii.] DISEASES OF THE PLACENTA.

623

sounds were faintly audible. About the middle of July, all foetal move-
ments ceased, this being preceded by griping pains in the abdomen. When
seen again, two months after, the uterine tumour was found smaller,
and no foetal heart’s sounds could be heard. On the 15th September,
labor pains commenced at midnight, and the patient was delivered of a
dead female foetus at 2 a.m.

Weight of foetus 25 ozs., length, 10£ inches. Weight of placenta, 2 ozs. j length of
funis, 11 inches.”

Presented by Professor II. Harvey.

27. A very excellent specimen of “ apoplexy ” of the membranes,

resulting in abortion at the second month. The patient was a
young native woman, aged 19. It was her second pregnancy.
The embryo and membranes were expelled entire, on the twelfth
day of a “ continued fever.” The inner surface of the latter
(membranes) is seen raised into several large nodules, which, on
section, are found to consist of coagulated (effused) blood.

28. “Apoplexy” of the placenta, with aborted ovum of about the

third month. No history. The placenta and membranes
conjoined, are from half to three-fourths of an inch in thickness,
and the inner (amniotic) surface is seen raised by a series of
smooth nodules, of dark-red or purplish colour. Some are as
large as an almond, others smaller. When a thin section is
made through the whole thickness of the diseased placenta, small
ecchymoses are found dotting it, and at these spots blood-corpus-
cles, undergoing disintegration, can very readily be recognised
under the microscope. The chorionic villi are atrophied ° their
cellular structure highly granular and fatty, but not much free
fat exists. The capillary vessels show similar degenerative
changes.

Presented by Professor T. E. Charles.

29. A very fine specimen of fatty degeneration of the placenta, from

a case of abortion. No history.

Presented by Professor T. E. Charles.

30. Hydatidiform degeneration of the chorion. No history.

Presented by Professor T. E. Charles.

31. Hydatidiform degeneration of the chorion, from a patient (a multi-

para) in the fifth month of pregnancy. She had suffered from
constantly repeated hemorrhages. On the last occasion, the
bleeding was so considerable, that the os and vagina had to be
plugged for five hours. On removal of the tampon, the os was
found sufficiently dilated to admit two or three fingers, and the
uterus was then rapidly emptied of its contents.

The structure of the diseased chorion consists of a series of larger and smaller
globular bodies, strung together like a bunch of grapes. ° These contain a
thin mucilaginous fluid, and the cyst-like wall is composed of delicate
capillary vessels, finely fibrillated connective tissue, and cell elements of
rounded or oval shape (three to four times the size of blood corpuscles)
all freely infiltrated with granules and molecules of highly refract;™
mucoid material. ° j no

Presented by Dr. J. Ewart.

624 EARLY BLIGHTED OYA. [sebies xviii.

32. An early blighted ovum, with apoplexy of the foetal membranes.

No history.

Presented by Dr. Cantor.

33. A similar specimen.

Presented by Babu Bissonatli Gupta.

34. An aborted ovum, of about the fourth week. The shaggy

chorion is well seen. The embryo contained within it has
become detached ; it is about the size of a rice-grain, and is
slightly constricted towards one pole (extremity).

Presented by Professor F. N. Macnamara.

35. An aborted ovum, with its membranes of about three weeks’

growth. The chorionic villi are well developed, as also the
amnion. It was discharged entire. From an East Indian lady,
aged 35 ; — first pregnancy.

30. An early ovum, — probably of about the fifth week. “ The larger
specimen consists of the decidua vera, of which a natural
dissection has been made to display the triangular outline of
the body” (? cavity) “ of the uterus. It measures an inch and
a half perpendicularly by a little over an inch across, — from the
opening of one Fallopian tube to the other. The smooth surface
is the internal or visceral, and displays the tumid rugose state
of the mucous membrane. The external or parietal surface is
rough, and covered with shreds caused by its separation from
the uterus. The smaller specimen has been opened by slitting
up the membrane. The delicate amnion is easily seen, and the
foetus, bent upon itself, measuring about five-eighths ot an inch
when unfolded. The exterior of the specimen consists of the
shaggy chorion.” (Ewart.)

Presented by Professor T. E. Charles.

37. An aborted human ovum of about the sixth week. From a Euro-

pean female.

38. Embryo with membranes, including the decidua, of about the

seventh or eighth week of utero-gestation. From a European
lady, aged 2G.

“ The cause of the abortion seemed to be, first, the lifting of a heavy
box, which was followed by a sensation “ as if something had
given way,” and, secondly, a carriage collision in the street, in
which the patient was greatly frightened.” (Ewart.)

39. An aborted ovum, of about the second month. The lower part

of the preparation consists of a firm blood-clot, moulded to
the shape of the uterine cavity. At the upper part, surrounded
by the shaggy chorion and delicate amnion, is the ovum. It
is nearly an inch in length ; the head and extremities are
apparent ; the former disproportionately large, and the eyes
indicated by black dots.

40. A human embryo, of about ten weeks. The head is large and
distinct, the outlines of the mouth and orbits are visible. The
upper and lower extremities are developed, and even traces oi
fingers and toes recognisable.

SERIES XVIII.]

ABORTED FOETUSES.

625

41. “ A fine specimen of a human ovum of about the tenth week.

The cause of abortion was marked retroversion of the uterus.
From an Eurasian female, aged 19,” (Ewart.)

42* A human fcetus ol about the twelfth week. Xt is three and a
half inches in length ; the head disproportionately large ; the
papillary membrane formed ; the mouth closed. The extremities
are well formed ; division into fingers and toes visible. The
umbilical cordis twisted.

Presented by Dr. W. K. Waller.

43. A human foetus “ about ninety days old.”

Presented by Babu Saroda Kanto Doss.

44. “ Human foetus and placenta” of between the third and fourth
month of utero-gestation. The placenta is diseased,— “ covered
with lymph deposit,”— probably fatty degeneration. The foetus
is small and shrivelled.

Presented by Professor T. W. Wilson.

45- 1 oetus, three and a half months old, aborted by a native woman on

the thirteenth day of an attack of acute dysentery,— which
subsequently proved fatal. It is five inches in length, and weighs
about four ounces. The nostrils and mouth are scarcely open
the eyes are closed. The fingers and toes are well formed. The
sexual organs distinctly indicate a male. The umbilical cord is
well-formed and twisted.

Presented by Dr. J. Ewart.

46. “Foetus of about the fourth month, enclosed in the amnion

(Colles)1 the plaC6nta which lecl to its expulsion.”’

Presented by Professor J. Fayrer.

47. Foetus four months old, aborted by a native female patient in

hospital, during an attack of cholera. It is well developed and
is preserved with the membranes and placenta complete ’

Presented by Dr. Francis. 1

4b. A human foetus four months old, with the membranes entire
the placenta attached to the cord. From a native female’
aborted in hospital.

Presented by Professor T. E. Charles.

49. Human female foetus, believed to be of about the fifth month
Aborted by a native woman during an attack of dysentery to
which she succumbed eighteen hours after.” ^ t0

Presented by Babu Chunder Mohun Ghose, m.b.

59. “ Human foetus, about five months old.” (Ewart.) The placenta
and cord remain attached, the membranes are wanting

Presented by Professor J. Fayrer.

51. “ Human foetus of the fifth month, with the cord and placenta
The chest and neck have been laid open, and the periSum
removed, so as to show the relations of the thymu ' "Sd to
the heart, lungs, and thyroid gland. The abdomen has been
opened by an incision to the left of the unbiS ami T*
anterior wall stretched by a glass rod, so as to show the con e
of the umbilical vein and hvpo°,astric artcru ” /n n \ coul&e
Presented by Professor D. B. Smith ^ (Golles>)

and

who

626 ABORTED FCETUSES. [series xviii.

52. “ Human foetus and placenta attached. The foetus is about the

the sixth month, and died in utero.” (Ewart.)

The preparation illustrates well the peculiar attitude assumed by the
foetus in the pregnant uterus, — the head bent upon the sternum,
the arms crossed over the chest, the thighs flexed on the trunk,
and the legs upon the thighs, — all the parts closely and
compactly packed together, so as to occupy the smallest amount
of space compatible with the size of the uterus, and the
development of the placenta, &c.

53. “ Six months’ foetus, enclosed within the membranes, with the
placenta, just as expelled during parturition.” (Ewart.)

54. “ Two foetuses of the sixth month (twins), one of which died

immediately after birth, and the other survived seven hours.”
(Ewart.)

Presented by Professor T. E. Charles.

55. A female foetus of about the sixth month. The anterior wall of

the thorax and abdomen has been removed, and the vessels
injected through the umbilical cord. The disproportionately
large size of the liver is well seen, as also the umbilical vein
and hypogastric artery. The relations of the thymus gland
to the heart, lungs, and trachea are displayed.

Presented by Professor T. E. Charles.

56. A human foetus of between the sixth and seven month. It is

fourteen inches in length, and about two pounds in weight. The
head is covered with fine brownish hair ; the eyebrows well
marked, and the nails formed. The pupillary membrane is dis-
appearing. .

Presented by Professor D. B. Smith.

57. “ Human foetus” (female), “ six and a half months old. (Ewart.)
Presented by Mr. Sakes.

58- Twin foetuses of about the seventh month ; one male, tne other
female. Both are somewhat small, but otherwise well developed.
The respective umbilical cords are attached to a single (common)
placenta.

Presented by Mr. Sakes. .

A well developed female foetus of between the seventh and eighth

“ A foetus in which putrefactive change has been far advanced
prior to birth. This is particularly marked in the extremities.”

«' A^foetus at the full term, badly developed, and much shrivelled
from defective nutrition in utero.” (Ewart.)

“ Putrid foetus, swollen and distended.” (Ewart.) The slim
presents a macerated and excoriated appearance in numeious

situations. No history. . ,

“ A foetus with an enormous hydrocephalic expansion ot the
bones and cavity of the cranium.” (Ewart.) The membranous
spaces between the bones are very greatly widened. No history.
“ A full grown foetus, delivered by spontaneous evolution, the
dark spots on the surface indicate the advances that putrefaction
had established prior to the expulsion of the child. (Evvait).
Presented by Professor Allan Webb.

59
60-

61.

64.

series xviii.] CONGENITAL MALFORMATIONS.

02 7

65. A specimen of so-called “battledore ” (fan-shaped) placenta, — the

cord or funis being attached to the margin or at the periphery of
this structure, instead of developing, as usual, from its centre.
Presented by Professor T. E. Charles.

66. ‘ A placenta, the cord attached to which has three umbilical
veins.” (Ewart.)

Presented by Professor F. W. Wilson.

67. Hydrocephalus. The head of a male foetus delivered by crani-

otomy at full term. When the head was punctured sixty-four
ounces of straw-coloured fluid were evacuated. This fluid was
slightly opalescent, had a specific gravity of 1005, and gave a
copious precipitate with nitric acid (albuminous).

“ The mother was a native woman aged 35. It was her seventh preg-
nancy. All previous ones had been easjr.”

Presented by Professor T. E. Charles.

68. A portion of the base of the skull of a native (male) showing
unusually large and symmetrically placed Wormian bones,— one
in either limb or half of the lamboid suture. Each is of oval
shape, about two inches in length, and one inch in breadth.

Presented by Honorary Surgeon P. A. Minas, Hissar.

69. Human skull (native) showing two unusually developed Wormian

bones, situated between the two parietal and occipital bones in
the position of the posterior fontanelle. They are separated
lrom the parietals and from each other by well-marked sutures
and the lamdoidal suture intervenes between them and the
occipital bone.

Presented by Assistant-Surgeon Kunji Lai Sanyal.

70. The lower jaw of a human foetus of about the seventh month —
prepared so as to exhibit the development of the teeth at this
early period of life.

Presented by Professor W. T. Woods.

71. A superior second bicuspid tooth showing an abnormal division of

its root into three fangs.

Presented by Professor W. T. Woods.

72. A second molar tooth of the lower jaw showing abnormity in the

number (three), and length of the fangs J

Presented by Professor W. T. Woods.

73.

74.

75.

A bicephalous foetal pig
A bicephalous foetal kid.

“ A duck!in» witk one perfect head, and the rudiments of a second
(Ewart )m§ing fr°m thG fight temP°ral a»d occipital region.”

76. A sparrow having two bills.

Presented by Mr. Blyth.

77. A kid with five legs,— the fifth being rudimentary, and projecting

from the pelvis between the two hind legs. J ject °

78. A puppy with six legs.

birth.”

Presented by Mr. W. Bason.

79. A gosling with four legs.

Presented by Mr. J. W. Long.

The animal died on the fifth day after

628 MONSTROSITIES FROM LOWER ANIMALS, [seeies xviii.

80. “ A chicken with two perfect and two rudimentary and imper-
fectly formed legs.” (Ewart.)

81. A double- bodied chicken, the union being at the thorax and

abdomen.

82. A double-bodied chicken, similar to the last preparation.

83. A chicken with four legs.

84. Monstrous foetal calf. It has a single head and body, but eight

legs.

Presented by the Civil Surgeon, Sambalpore.

85. A double-headed duckling.

Presented by Assistant-Surgeon Durga Das Lahiri.

86. “ A double monstrous kitten, with one head and face. Thorax

and abdomen joined together.” (Ewart.)

87. A double -bodied pig, but with only one head.

88. “ A monster kid, having two bodies united together by the

thorax and abdomen, with only one head.” (Ewart.)

89. “ Part of what would appear to be a monstrous kid or an

abortive mis-shapen calf. It is an anencephalous production
possessing a spinal cord, par vagum, and great sympathetic
nerve. The spinal marrow and nerves are illustrated in the
normal condition.” (Allan Webb. Path. Ind ., No. 578, p. 291.)

90. 91- Two specimens of monstrous chickens, each having four
legs. The bodies are conjoined, yet there is but a single head
in each case.

Presented by Dr. C. R. Francis.

92. Cyclopean pig. The single orbit is situated in the median line,
just below the forehead. "The eyeball is large and malformed, as
also is the fcetal snout.

93 A similar specimen. “ A monstrous fcetal calf. There is only one
ocular socket containing the eyeball, which is provided with two
cornea?, and protected by imperfectly developed upper and lower
eyelids. The eye is in the centre of the forehead, — cyclopean.”
(Ewart.)

94. Foetal pig showing a curiously deformed condition of the head.

There are two snouts, two ears, and two well-formed eyes, but a
rudimentary third eye is seen about midway between the other
two, at the lower part of the conjoined forehead, giving thus a
cyclopean appearance to the anterior aspect of the monster.

95. “ A monster lamb, having two bodies joined together by the union

of the thorax and abdomen, with one malformed head,” which
possesses three ears but no eyes.

96 A pig with a head analogous to that of an elephant. It lived
an hour after birth.” (Ewart.)

Presented by Professor Walker.

97. A monstrous puppy. The ears are misplaced, there are no eyes,

and the nostrils are rudimentary and imperfect.

98. The foetus of a horse enclosed in its membranes, — of about the

fourth month of utero-gestation.

Presented by R. S. Ilart, Esq., m.e.c.v.s., Calcutta.

suniEs xix.]

INDEX.

629

\ v

Series XIX.

ENT0Z0A FROM VARIOUS PARTS OF

THE BODY.

INDEX TO THE SERIES.

I. -TKEMATODA (FLUKES)—

]. — Distoma hepaticum (fasciola hepatica), 1, 2, 3, 4.

2. — Distoma conjunctum, 5, 6, 7.

3. — Distoma sinense (McConnelli), 8, 9, 10, 11, 12, 13.

4. — Amphistoma hominis, 14.

II. — CESTODA (TAPEWORMS) —

1 . — T.ENI2E —

(a) . Taenia solium, 15, 16, 17, 18, 19.

(b) . Taenia mediocanellata, 20, 21, 22, 23, 24.

2. — Echinococci (hydatids), 25, 26, 27, 28.

III. — NEMATODA (ROUNDWORMS AND THREADWORMS) —

1. — Ascaeides —

(a) . Ascaris lumbricoicles, 29, 30, 31, 32, 33, 34, 35.

( b ) . Trickoceplialus dispar, 36, 37, 38, 39, 40, 41, 42.

2. — Oxyueides—

(a). Oxyuris vermicularis, 43, 44.

3. — Filaeije—

(a) . Filaria (Dracunculus) medinensis, 45, 46, 47, 48, 49, 50, 51.

(b) . Filaria liominis oris, 52.

nalis), 53, 54, 55, 56, 57, 58, 59, 60, 61, 62.

IV. — PARASITES FROM THE LOWER ANIMALS—

1. — Distoma, 63.

2. — TiENiA, 64.

3. — Cysticerci, 65, 66, 67, 68.

4. — Echinococci, 69, 70.

5. — FiLARiiE, 71, 72, 73, 74, 75.

■

630 DISTOMA CONJUNCTUM. [series xix.

X. A distcma hepaticum. No history.

2. “ Several specimens of distoma hepaticum, from a patient who died

of hepatic abscess.”

Presented by Professor S. B. Partridge.

3. Three distomata (D. hepaticum) from the liver. No history.

Presented by Baboo Nundo Lai Gliose.

4-. “ A hundred and thirty-three entozoa found in the small intestines

of a man.” These are typical and excellent specimens of the
Fasciola hepatica or common liver-fluke. No history.

Presented by Assistant-Surgeon Bani Madub Bose, Rajmehal.

5. Several (more than a dozen) distomata removed from the bile-ducts
of the liver. From a case of dysentery, — a Mahomedan (male),
a^ed 2L They were found singly or in twos, threes, or even
groups of four within the ducts, either lying flattened or variously
coiled upon each other. They belong to the species Bistoma con-
junctum (of Cobbold), and constitute the first and original “ find ”
of this variety of fluke in man (9th January L87G).

Description of the Distoma. Average length f" (three-eighths of an inch) ; average
breadth -Jo" (one-tenth of an inch). Ova of the usual type, i.e., oval in
outline, with a double contour, and a transverse marking at the narrower
end (where the operculum separates) ; contents granular ; average length
Pso" > average breadth rinnr"- The body of the fluke is flattened, lanceolate,
extremities pointed— the posterior more obtusely than the anterior. Oral
and ventral suckers in the median line, — the latter smaller than the former —
(oral about ventral about in diameter). Surface of the body

covered with delicate spines or hairs, most numerous or thick-set over the
anterior half of the same. Alimentary canal double and unbranched ;
terminates within a short distance of the posterior extremity of the parasite.
Reproductive orifice situated a little above and to one side of the ventral
sucker. Uterine folds and ovary in median of body, immediately below the
ventral sucker. From the ovary, on either side, proceed the vitelligene ducts
to the vitelligene organs (dark, dotted, and pigmented bodies) lying on either
side of the fluke, between the alimentary canal and integument. Below
the ovary two very distinct rounded or globular bodies — the testes, placed
one on either side of the median line of the body, and not on the same
level (one a little below the other). An indistinct, delicate, efferent duct
(fas efferens) passes upwards from the higher of the two testes, and above
the ovary, — to probably the reproductive papilla. In the median line, at
the posterior extremity of the body, the aquiferous canal commences ;
dilated at first, becomes narrow as it winds upwards between the testes,
and then branches into two water-vascular channels.

[ See further, “ On the Distoma Conjunctum as a human entozoon ” by J. F. P.

McConnell, m.b., the Lancet , 4<th March 1876, p. 343, and the Veteri-
narian, April 1876 ; also prep. 353, Series IX.]

6. Distoma conjunctum. Six flukes from the hepatic bile-ducts of a
native maie (Hindu), who died in hospital from cholera.

The bile-ducts were dilated, their walls thickened, their lining mem-
brane soft, — in a catarrhal condition. No distomata were found
in the gall-bladder, which was distended with about two ounces
of very dark grass-green bile. The liver generally was
hvpersemic, — much fluid blood in the large portal and hepatic
vessels. Hepatic parenchyma soft and greasy ; lobular structure
fatty.

SERIES XIX.]

DISTOMA SINENSE.

631

All the flukes were dead, though the autopsy was performed within two
iours after death, and before the rigor mortis had set in. None
were found in the alimentary canal, though a round-worm
{A. tumbmcoides ) was discovered in the jejunum
7. A large number of distomata (D. conjunctum) removed from the
naiv canals of the liver of a Mahomedan (male) coolie, aged 18
wio died in hospital of acute dysentery. They were found in
twos and threes, or in little colonies of six or eight -coiled

(See pStSlX^ bile‘dUCtS ^ ai'd “ generally.

1,1 tliej(trprVNo!e54)me C#Se *eTOral sclerost0»^ were discovered,

“Medical Post-rntrUm. Records," vol. Ill, 1879, pp. 203-4.

8' Wr of a “fh02611 free lj,s„‘omata’ found in the bile-ducts of the
liver o a Chinese, aged 20, a carpenter. They present a some-

T. «v } 4 shruil!ten appearance from long preservation in spirit

on tVe°n9Sth of “s ’,er, J7 speoies’ and were discovered

Professo, Coldfol, f fw F r4n- Th<* 1,av,e received fro»

j. lotessoi Lob bold the name of Distoma Sinense. T’he condi-

Series IX* lver 1S descnbed in eonnection with prep. No. 352,

The specie^ measures iV' (seven-tenths of an inch in length j.// ,

of an inch) in breadth ; the ova by -il" bj 7 (one-seventh

lanceolate; anterior and posterior ‘ • ^ na,TOW> flattened,

obtusely (ovate). The surface of the body i mit! ft T™

Tin, lead, („t„Te “ "''“'defined sjfinncto
bifurcate, in the merhan lfne if the b]Sv h *1° fa- fs"PhnS"9- The latter
sucker), into two alimentary eanals.Jfhdire aboie ‘lle ™trai

and outwards along the sides of the body 8li£htTwid5 7 downwa^s
and converge again towards the caudal fxtremit! ^ as they proceed,
terminate in blind cul-dc-sacs ThM« extiemity, close to which they

On the inferior surface of ' the' b Jdy fc the ventra? lbl'aJlclied throughout
median line, and about one sixth of an il l! i!? 1 ^cker, situated m the

P ““ “1 ^C‘as8U,troril !l

JU>t “^e^^X^Sin^fof:1 convof , j*"* ««

structure 1, well dejlpld anl eoS^f TMtm- Thi‘

windings, which communicate posteriorly with n fl i ? °f vcr^ int™ate
shaped body,— the ovary. Occupying the i»fe flatt®ned> somewhat square-
canals and the lateral 'borders of the h i f ^l3pace3 between the alimentary
pigmented-looking yitelSene sJruetures ^ eitber side’ are the dark,
ovary hy mean, of two ‘hi

“ll My, the testis ;

dendritic-looking str^tures^amon"5 S£f?Ul“r dTl0pment of inched

smaller testicle can be distinaufshed ^Tlffr6™1 sPfcim-ens> a rounded
re^XctluZlLilZ malC genemfcive °rgans> and Po™s, pLhapsC,aaSkiud of

thread-like 11^8^0^^ f US’ a VCrj dclicate

lower border of the ovary and abo/e the e ,nfl f larSer testis, to the
genual orifice. This is the seminal efferent S-flt' **

632

DISTOMA SINENSE.

[SEEIES XIX.

At the caudal extremity of the body of the fluke is a pulsatile vesicle or bulb ; the
continuation of the same upwards, as a water-vascular canal, can also be
clearly distinguished.

\_Seo further, “ Remarks on the anatomy and pathological relations of a new species
of liver-fluke,” by J. F. P. McConnell, m.b., the Lancet, August 18/5;
and “ Parasites or entozoa of man and animals” by T. Spencer Cobbold,
m.d. E.K.S., 1879. p. 28].

9. Several distomata ( D . Sinense , McConnelli) , removed from the

biliary canals of a Chinese (male), aged 28, who died in hospital
from tubercular phthisis. The flukes were alive, and exhibited
undulatory movements when placed in water. The autopsy was
performed three hours after death.

( See further, prep. No. 351, Series IX, and “ Medical Post-mortem
Records,” vol. III., 1879, pp. 81-82.)

10. About thirty distomata (D. Sinense), six of which were found in

the gall-bladder, and the rest in the bile-ducts of a Chinaman,
(Achoo), aged 40, a carpenter, who died in hospital from
remittent fever. ( See also prep. No. 355, Series IX.)

Over a dozen distomata ( D . Sinense), from the bile-ducts of the liver.
The latter was enlarged and soft ; the lobular structure indis-
tinct ; the biliary canals prominent, dilated, and full of thick

yellowish secretion. #

The flukes were, all but one, found singly, or in twos and threes, coiled
upon themselves in the bile-ducts ; one was in the gall-bladder.
None in the intestine or its contents.

The patient was a Chinese, aged 35, by occupation a carpentei, who
died in hospital from malarial anaemia and exhaustion, with
cancrum oris, hypertrophied spleen, &c.

12. Distoma sinense — McConnelli. About fifty specimens fiom the
bile-ducts of a Chinaman, aged 35, who died of clnonic dysenteiy,
(See further, “ Medical post-mortem Records,” vol. Ill, 1880, pp. 703-04.)
13 About thirty distomata (I). Sinense), from the liver of a Chinese
carpenter, aged 40, who died of remittent fever. The liver sub-
stance generally was extremely soft and friable ; of a dark olive
colour ; the bile-ducts dilated, filled with thick yellowish secre-
tion, and occupied by these flukes in numerous situations. ^
(See further, “Medical Fost-mortem Records,” vol. HI, 1880, pp. 733-

14. Amphistoma hominis (Lewis and McConnell). “ The coecum of
a native prisoner who died from cholera in the liihoot gao
hospital, with a number of peculiar and probably hitherto unrecog-
nized parasites, found alive in that part of the intestinal canal.
The prisoner, Singhesur Doradh, aged 30, was attacked with cholera
on the 13th, and died on the 14th July 18o/. Had not been
in hospital previously, and was employed in cleaning the jam
The post-mortem examination was made three hours after
death --“Colon externally livid, contracted; contains a little
serous fluid with flakes of mucus. Mucous membrane healthy
except venous congestion. In the caecum and ascending co on
numerous parasites like tadpoles, alive, adhering to the mucous
membrane by their mouths. The mucous membrane marked

SERIES XIX.]

AMPHISTOMA HOMINIS.

G33

with numerous red spots like leech-bites from these parasites.
The parasites found only in the coecum and ascending colon,
none in the small intestines.” * * # * “ They are of

a red colour, size of a tadpole, some young, others appar-
ently full grown, alive, adhering to mucous membrane, —
head round with circular open mouth which they had the
power of dilating and contracting. Body short and tapering
to a blunt point.” ( Description by D>\ Simpson.)

In the preparation, the majority of the parasites were found free,
i.e ., detached from the surface of the bowel, but others are
seen to be still slightly adherent or entangled in the folds
of the mucous membrane. The solitary glands are through-
out prominent and hypertrophied, a condition which, although
very common in cholera, appears, in this instance, to have
existed (and still persists) in a very remarkable degree, —
probably on account of the great follicular irritation which these
parasites, by their presence, are likely to have excited.

Description of the amphistoma. — Greatest length, from i" ' to §", greatest breadth
to i". At the anterior pointed extremity is the oral sucker ; and about
-j V' below this is the genital pore. The posterior half is composed of a
somewhat flattened, circular bursa, within which is placed the caudal
sucker proper. The latter is a firm cup-shaped organ, composed of circular
and radiating muscular fibres. Its orifice is about -}$" in transverse
diameter. The oral sucker consists of a transversely placed oval orifice,
leading to a bulbous, heart-shaped pharynx, on either side of which are
nervous ganglia giving off nervous filaments in all directions, and especially
two large cords which may be traced along the ventral surface of the two
intestinal canals. The oesophagus is -jV' or tV/ m length, bifurcates a
little above the genital pore, and the two canals thus formed terminate
coecally about opposite the middle half of the caudal sucker. Closely
attached to the canal on either side are the main branches of the water-
vascular system. Into the genital pore open the two channels of the
sexual apparatus of this hermaphrodite entozoon. The vagina, in mature
specimens, is filled with ova. The convolutions of the vagina and uterus
occupy a great portion of the interior of the worm. In front of these
convolutions, as seen from the ventral aspect, is the ovary, and closely
adjoining are the lobulated testes, from which the vas deferens with its con-
tinuation, the ductus ejaculatorius , may be traced.

The ova have firm capsules, and are provided with opereula ; they average in
length, by 340' hi diameter.

These specimens of ampliistoma constitute a species entirely new to
science, and, with the exception of certain specimens of the same
parasite collected by Dr, J. O’Brien of Gowhatty in June 1871,
— (now in the possession of Dr. T. It. Lewis of Calcutta) —have
not been previously described, nor, indeed, have any species of
the genus to which they belong been, heretofore, found to affect
man.

[See further, “ Amph. hominis, a new parasite affecting Man.” By T. R. Lewis and
J . F. P. McConnell ; Proceedings of the Asiatic Society of Bengal
August , 1876 ; also Cobbold on Parasites of Man and Animats , 1879, p. 36.J

Presented by Dr. Simpson, through Professor E. Goodeve.

15. “ Taenia solium expelled by a single dose of Ivameyla powder. The

head is not preserved.” (Ewart.)

634 CESTOID AVHBMS (HENT.dE) [seeies xix.

16. Taenia solium, showing the upper or anterior portion of the '

worm, and the very minute character of the segments as the
neck and head are approached, neither of which has, however
been preserved.

17. “The greater part of a tapeworm” (T. solium), found near a

diverticulum of the small intestine of a man who died, a few
hours after admission, from intestinal obstruction caused by a
twist of the end of the ileum.” (Ewart.)

18. A portion of a tapeworm, (1 . solium), which measured about

twelve feet. The head is wanting.

'Presented by Babu Womesh Chunder Dass.

19. Taenia solium. A portion of a tapeworm passed per rectum in a

curiously twisted and knotted condition, by a European sailor
suffering from dysentery.

Presented by Professor Norman Chevers.

20. Taenia mediocanellata. The truncated square-shaped head of this
variety of tapeworm, and its four suckers (unprovided with
booklets), are \vell seen in this preparation.

“The entozoon after removal from the body, at the post-mortem examin-
ation, was exceedingly active in its movements, and was mounted
on talc prior to death, hence the unusual appearance of the
proglottides.”

Presented by Professor Norman Chevers.

21. A very fine specimen of Tsenia mediocanellata. The head, how-

ever, is not present.

22. Portions of twotsenise (T. mediocanellata), from the small intestine

of a European sailor. The heads of both worms are readily
recognisable.

23. The head, neck, and about six inches of the upper portion of a tape-

worm (T. mediocanellata) found in the small intestine of a native
male patient - (a Mahomedan), - who died from dysentery.
The characteristic square-shaped head with its four large suckers
is well seen.

24. The head and about twelve inches of the body of a mature tape-

worm (T. mediocanellata), removed from the small intestine of a
Hindu, aged 50, who. died of pneumonia. The worm was alive
when found at the post-mortem examination.

25. “ Two acephalocysts from the spleen of a patient in the Native

Hospital.” (Ewart.)

26. “ Portion of a cyst of a tumour displaying a clustering mass of

small hydatids in various stages of development.” (Ewart.)
No history.

27. “ A hydatid cyst, as large as the foetal head, in the right lobe of

the liver of Private James Middleton, H. M.’s 51st Light Infantry,
who died at Shyra Gullee, nine miles from Murree, in August
1863. The cyst has led to absorption of part of the right lobe,
only a small lamina of hepatic parenchyma being now seen sur-
rounding part of the tumour.”

History. — “ The patient took ill and died within nine hours. The cause of death
was considered (after the autopsy) to have been rupture of the hydatid
cyst, which was supposed to be owing to a shock, rather than a fall, which

SERIES xir.]

HYDATIDS OF THE LIVER.

G35

“ The

the man sustained two or three days before, while sitting astride of a
branch of a tree. The shock was of some force. At the time “ he felt
something had given way in his inside,” and his testicles were slightly
hurt. The symptoms, on admission into hospital, wero coma, with 'ster-
torous breathing, feeble action of the heart, with loss of pulse, deep but
slow inspiration. Pupils were contracted. The treatment was cold douche
to the head and stimulation. The man rallied a little, and latterly was
capable of being roused when spoken to in a loud voice, and indicated the
umbilical region as the seat of pain ; he was not ablo to reply to questions.
I lie prostration was extreme, the pulse extinct, and the man ranidlv
sank.” L J

At the autopsy— (every organ but the spinal cord was examined)— the only appre-
ciable cause of death was discovered in the liver, which was the seat of an
enormous sacculated cavity, extending throughout the entire thickness of the
right third of the right lobe, and reaching a couple of inches below its inferior
margin The lining membrane of the cavity is of great thickness and strength
Lying loosely within it was an opaque milk-white sac of great delicacy
and ruptured, but it was partially tilled by a transparent and clear fluid!
There was no purulent admixture. A peculiar grey granular sediment
was noticed on the sac. The substance of the liver was healthy, without
a trace of recent or remote inflammation. But there were strong and
extensive adhesions to the neighbouring parts. 93

nT^Trr°[ modfafce ™uscular development, and, on reference to his
Medical History Sheet, the surprising fact was discovered that, since his
enlistment in 18o5, he had only been eleven days in hospital for inter-
mittent fever, two years ago. He was known as a healthy man, and

tlm la-ht'shle0” mdeS remember thafc He ever complained of pain in
Presented by Dr. R. F. Lyons, Assistant Surgeon, H. M.’s 101st Rood

28. A large number of hydatids found within a parent-cyst, about
the size of the foetal head, situated in the upper and posterior
portion of the right lobe of the liver. ^

The patient was a Scotchman, aged 49, Chief Officer of a sailing vessel.

“He was a man of very bronzed complexion from exposure, and was sallow on
admission. Was admitted into the Presidencv General wnsn-tni
6th September 1880. Had suffered from ^ dysente^v in STJV” 6
ously. Left England in May (1880), ingood'hS
15th July had two severe rigors, -lasting half an hour. Has suffered
from constant constipation and frequent vomiting, with severe min

buukV G* °*WC * *n m ,llVCr, CT°r 8ince’ and has bccn confined to his

i • . . 1 bysical examination showed enlargement of tho

? * w -Wfo'ix as •PP&

liver dulncss was found extend to within two finger.'^ breadK the £?
of the umbilicus. From the 14th there were occaSal Zors fcB
by considerable evening rise of temperature, and great mi.P„ i T“
regron and right ilant. On th/ 25th, the iivfr wS oinSed
diagnosis being probably liverabscess-and fourteen ounccs'b 7i ; a
tenacious pus came awav followed bv »l««, ounces ot very thick

The needle, on withdrawal, was found blocked by si LlT vS

tissue, and several similar pieces were discovered in fhT !£, h lt,e
These oU presented the appearance, of portions of a snppniting'vS

Temporary relief was only afforded by the operation which had tn i
on the 28th, on account of great local pain and dyspnoea This

“ Tliere was no fluctuation to be felt in the liver from ^ i

carefully looked for. The resistance offered by the liver was marked^and

636

A SCAR IS LUMBRICOIDES.

[series XIX.

considerable force had to be exerted in using the aspirator needle. There
•was no jaundice until the 25tli September. Rapid emaciation during
the last fortnight.”

“ At the post-mortem examination, held on the 29th September, the liver was
found adherent to all the surrounding tissues, except at the anterior
under surface ; and, on attempting to remove the organ, the knife pene-
trated a large abscess-cavity at the upper right surface of the right lobe.
There was a gush of pus mingled with opaque cyst-membranes in large
numbers. The cavity was lined by a thick opaque membrane, which
readily peeled off. Above and behind was a large cyst, which was also
opened during removal, and which contained perhaps two pints of clear
fluid under great pressure, for it escaped with great violence into the
right pleural cavity, and with it came out several large transparent cysts,
like jelly-fish, and numerous smaller ones. The bile-duct was distended
to the size of an ordinary thumb, and was found to be blocked, at its
lower part, by a piece of opaque bile-stained membrane. It contained
also several pieces of transparent bile-stained cyst-membrane, and much
gelatinous bile-stained substance of the consistency of jelly. The gall-
bladder was about the size of a small egg. The surface of the liver
was much nodidated. The other organs were not carefully examined.”

( Note by Dr. Joubert.')

The anterior cyst which had suppurated [see prep. No. 351, Series IX),
has a distinct lining membrane, two to three lines in thickness,
is soft, pulpy, and pus-infiltrated. The posterior cyst has an
equally thick wall, which, however, is tough and leathery in
consistenc}T. Above, it reaches and is adherent to the diaphragm.
The liver-parenchyma is throughout bile-stained. The inter-
lobular tissue slightly thickened (cirrhotic). The acephalo-
cysts are more than forty in number, and vary in size from that
of a small orange to that of a pea, are clear and trans-
parent, or, some of them, partially bile-stained. With these
are preserved large fragments of the semi-transparent endo-cyst
belonging to the posterior parent or mother hydatid-sac, which
escaped at the same time as the brood of echinococci contained
within it.

Presented by Dr. C. H. Joubert, Presidency General Hospital,
Calcutta.

29. “ Sixty -seven lumbrici taken from the stomach and small intestines

of a woman who had suffered from diarrhoea and vomiting for
a year and two and a half months. All the organs were found
healthy.” (Ewart.)

Presented by Professor F. W. Wilson.

30. A male and female round worm— A. Lumbricoides. The curved
inferior extremity or tail of the former is well seen, as also the
projected spiculum.

31. “ A portion of the ileum containing a lumbricus. The entozoon

is bent upon itself, so that both its caudal and cephalic extre-
mities are seen.” (Ewart.)

32. u Seventy-five (75) round worms removed from the bowels of a

native male, in a single day, after the administration of a few
grains of santonin.” (Ewart.)

33. “Seven hundred and seventy-five (775) round worms passed by a

child, named Ghafoor Alii, aged one year and nine months.
Between the 20tli and 25th April (1867), 6,000 of these worms

SEBIES XIX.]

TEICHOCEPHALUS DISPAE.

637

34.

35.

36.

were passed under a treatment consisting of large doses of
calomel and scammony, followed by turpentine and castor
oil. The worms, now preserved, were passed in one stool.
'I hey are from two to seven inches long, and weigh from
one to seven grains. On one occasion the child passed 2,750 of
these worms.” (Colies.)

Presented by Dr. S. C. Townsend, Civil Surgeon, Nagpore.

A typical specimen of lumbricus (A. lumbricoides— female) passed
“by a European gentleman.”

A large sized round worm ( A . lumbricoides) curiously twisted upon
itself so as to form a knot. It was found, with six others, in the
jejunum of a native male, aged 40, who died in hospital of
cerebro-spinal meningitis.

“ Trichocephalus dispar, found in the stomach and small intestine
(but not in the large intestine) of Bajoo, a Hindu male, who
died of cirrhosis hepatis.” (Colies.)

Presented by Professor Chuckerbutty.

37. A large number of whip-worms {Trichoc ephalus dispar), removed
rom the ccecum of an East Indian boy, aged seven years. Several
were attached by their delicate filamentous heads to the mucous
r membrane of the bowel, the rest were free.

I he ccecum and a portion of the ascending colon of a native e-irl
aged eight years. The former is seen infested by whip-worms
( Irichocephalus dispar),— a large number adhering to the mucous
membrane. The latter (colon) exhibits chronic, superficial
pitted, dysenteric ulceration. ^ 5

A large number of Trichocephali removed from the ccecum of a
native female, aged 41, who died from (idiopathic P) Tetanus

,« W r V p J!JUnUm t Vrfceen round worms (lumbrici) were found

( Medical L ost-mortem Records,” vol. Ill, 1871), pp Go-GO )

40. rm • ’ •

39.

41.

The ccecum occupied by a small colony of whip- worms (Tricbn
F‘Um a “atiVC ma‘°’ ^ «». who died of

42.

fibroid phthisis.

The ccecum ad. portion of the ascending colon of a
male patient, aged 30, who died from hepatic cirrhosis To
he mucous sur ace of the bowel numerous trichocenhah
Inchocephulus dispar) were found adherent. Several '
s ill be seen attached, but a great many have dropped off
I he ccecum infested bv » 1 1 uir-

may

43.

IV. emeum infested by a

cephahis dispar). The host was an Hast Indian male a Led 4<f
who died from morbus Brightii ’ ° du>

fr0m “ XWchti:

(•' Obstctnc Post-mortem Eeoords,” vol. I, 1880, pp. 71.9.50 1
44. Thread-worms collected from the evacuations ,,f ,

children attending the medical dispensary of'thc hosS "at‘Ve

4° t ST* KOrm «**«4 abort Tftohos in

638

FILARIA MEDINENSIS.

[SEEIES XIX.

46. Filaria or dracunculus medinensis. Another specimen, about 18

inches in length.

47. A portion of a Guinea worm, measuring about 20 inches.

48. “ An entire Guinea worm, forty inches long, removed from John

Michael, a Jew of Nineveh, aged 40. Two other filarim had
been removed from this patient, but were broken in the process.
(Colics).

Presented by Professor J. Fayrer,

49. Six Guinea worms (_Z). medinensis ), five of which are entire,

and the two largest about thirty inches in length. “ These
were extracted from prisoners in the Sirsa Jail Hospital, during
the rainy season of 1871.”

Presented by Honorary Surgeon J. Rehill, Civil Medical Officer, Sirsa,
Punjaub.

50. About twelve inches of a Guinea worm ; the hooked caudal extrem-
ity is well demonstrated.

Presented by Hr. A. Crombie.

51. A Guinea worm (F. medinem sis), eighteen inches long, removed

from an abscess in the calf of the leg of a Hindu, aged 30. He
was an inhabitant of Furukabad, where the worm is not known,
but a year ago, he went to Sudwar on the Jumna, and resided
there for five months. About four months ago, he experienced
an itchy sensation in the calf of the left leg ; gradually an ulcer
formed, and he then detected the worm. . On attempting to
remove it, the worm broke after about six inches, had been
drawn out. The rest remained imbedded in the tissues ; the
part became very painful, and a fluctuating, swelling developed.
On admission into hospital this was incised, and the^woim
escaped with a considerable quantity of very offensive pus.”

Presented by Professor J. A. P. Colies. . .. . ,,

52. Filaria Tiominis oris,— a nematoid worm “ vomited by a child.

The entozoon is 5£" in length, and about ,Y' broad. It has a

brownish colour, but is so opaque and hard from long preserv-
ation in spirit, that even after several days’ maceration in
glycerine-solution nothing can be determined as to its internal
structure. The anterior extremity is truncated, and here a simple
rounded buccal cavity or mouth is distinctly recognisable. The
posterior extremity is obtusely pointed ; — has no spicula. l ho
filaria seems to be immature, and corresponds most closely w ith
the F. hominis oris of Leidy.

I Vide, Proceed. PJdladelph. Acad, of Nat. Science*, 1880, P^m. quoted by Cobbold
in Parasites ancl Entozoa of Man and Animals, 187 J.p.

Presented h, Hr. J. H. Condon, Civil Surgeon, Cawnpore. .

53 ’ About a dozen “ Sclerostomata” (S. duodenale vel Bochmius duo -
denalis), found adherent to mucous membrane of the jejunum
From a native male patient, aged ~o, who died of chi on
dysentery, — (Oth January 18/0).

, . 4- * i f ao tVin first recorded ^find^ of this worm in Indiftj ■

It is carefully looked for previously. Since the above date

these parasites have been discovered in numerous cases, and, m fact, seem

flEBIES XIX.]

SCLEROSTOMA DUODEiSTALIS.

639

to be by no means rare, as accidental entozoa, in the small intestines of
natives oi Bengal. It is questionable, however, whether they, as frequently,
produce any specific symptoms or lesions. The anaemic chlorosis described
by Griesinger in Egyptians, and the hypoaemia associated with these
vorms in Brazilian subjects, recorded by Wucherer, are conditions which
have not so clearly been traced to the presence of these worms in the cases
observed here. Although, in the majority, anaemia was a prevailing
element, yet it seemed to be attributable, more specifically, to dysentery
and malarial complications, and but indirectly, if at all, to these parasites ;
and, in several cases, they hare been encountered in subjects dying from
some acute or sthenic disease, where the organs and tissues of the body
pi esented no bloodless condition, but, on the contrary, their general appear-
ance precluded the existence of this condition during life. On the whole
therefore, the presence of sclcrostomata in the bowels of people of this
country appears to be accidental. Is probably nearly as common as the
round worm (lumbricus) in natives ; and it has jet to be determined
whether these entozoa are the efficient cause of any recognisable disease or
disorder.

The anatomical characters of these nematoids correspond, in all essential
particulars, with those described by the discoverer (Dubini), and
subsequent observers.*' They are, however, by no means confined
to the duodenum ; in fact, have more frequently been found in
the jejunum, and even lower down in the small intestine. The
females always predominate, — in about the proportion of five
to one male dochmius.

(See further, “ Medical Post-mortem Records,” vol. Ill, 1879 pp 5-6)

54. Dochmius duodenalis . About twenty of these worms (male and

female), removed from the jejunum of a Mahomedan coolie
acred 18, who died in hospital from acute dysentery. The biliary
canals of the liver in this case were filled with flukes of the variety
_ known as distoma conjunctum (see prep., No. 7.) J

“Medical Post-mortem Records,” vol. Ill, 1879. pp 203-01 )

55. A lvnnl n 71 1 j i / ” i _ .

56.

57.

58.

About half a dozen sclcrostomata (S. duodenale), from the
duodenum and. upper part of the jejunum of a native male
(Hindu) who died from erysipelas, after the operation of removal
of an elephanto.d scrotum. In the thin fcccal contents of
the large intestine one whip-worm (Trichocephalus dispar) and
one thread-worm (Oxyuris vermicular is), were found
About a dozen sclerostomata, male and female, collected from
t ie duodenum and jejunum of (1) a native boy, aged 12 who
died from malarial anaemia and exhaustion ; (2) a native male
aged about 40, who died from chronic bronchitis with bronchiec-
tasis ;--no anaemia no bowel lesion ; - (3) a native male, aged 30
v io died from remittent fever no anaemia, no bowel lesion ’
Dochmius duodenalis. About twenty-four of these worms (both
male and female), found in the contents of the small intestine of
a native male, aged 32, who died in hospital from chronic
malarial anosmia and dysentery. omc

Iifty sclerostomata (male and female), from the small intestine

of a native male (Hindu), aged 28, who died of acute cereb -o
spinal meningitis. ^citoio-

* 8* especially Cobbold, on Parasite , and Entozoa of Man and Animals. 1870,

P. 211

640

CYSTICERCUS CELLULOS2E.

[SEEIES XIX.

59. About forty of these same worms collected from the jejunum and

upper part of the ileum of the following cases: — (l) four, from
an anaemic native (male), aged 40, who died of dysentery ; (2) two,
from a native male, aged 25, who died of pneumonia, (no anaemia) ;
(3) eighteen, from a native male, aged 26, who died of traumatic
tetanus, (no anaemia) ; (4) over a dozen, from a native male,
aged 26, who died of cirhosis of the liver, &c. (anaemic).

60. The pyloric end of the stomach, the duodenum, and a portion of

the jejunum, with numerous sclerostomata, adhering to the
mucous membrane of the intestine. F rom a native male,

aged 26, who died of morbus cordis.

61. More than a dozen sclerostomata (S. cluodenale), found in the

thin fcecal contents of the small intestine . of a native male,
(Hindu), aged 35, who died of acute sloughing dysentery ; and
also, about half a dozen of these same parasites from the
jejunum of a native (male), aged 30, who died from pyaemia,
following a compound comminuted fracture of the foot.

62. The duodenum of a native male, aged 30, who died from cirrhosis

of the liver. A large number of sclerostomata are seen adhering
to the mucous surface.

Two distomata ( Fasciola hepct licet) , from the bile-ducts of a
portion of the liver of a cow. They are opaque, brownish-looking,
an inch and a half in length. The oral and ventral suckers are
well-marked, and, just above the latter, is the protruded spiial

penis of the fluke. .

bile-ducts were considerably dilated, and their walls tluckenec*,

rigid, and partially calcified.

Tania serrata from the dog, — the mature tape-worm of the

cysticercus pisiformis. . . .

Cysticerci teenies mediocanellates. A portion of measly beef
exhibiting these parasitic cysts, which vary in size from that of
a barley-grain to that of a pea.

Presented by Mr. J. Bowser.

63.

The

64.

65.

66.

The

Cysticercus ( teles ) celluloses. Two sections of muscular tissue
of the pig infected by cysticercus (“ measly pork”),
parasites are seen to be diffusely scattered in the flesh, and form
1 little bladder-like or vesicular bodies, varying in size from that
of a mustard-seed to that ol a pea, a few still laigei. On
dissection, each such vesicle is surrounded by a delicate cyst of
connective tissue (containing also a few elastic filaments), which
isolates it from the surrounding muscular substance. _ The cysti-
cercus proper is rounded in outline, has an outer delicate trans-
parent membrane, and an inner granular layer, within which lies
the embryo, and from which it can be squeezed out on forcible
pressure. The slightly conical proboscis or head, with its double
circlet of hooks, and four suckers, is clearly demonstrable ; and, in
some specimens, seems to have undergone further development,
so as to show a transversely laminated structure behind the nead
tie. the neck and commencement of the body). In others or
these capsules a considerable portion of the scolex or larva of
the parasite is observed, forming a coiled vermiform body, in

series xix.] ECHINOCOCCI (AKEPIIALOCYSTS).

Gil

which the transverse striation, above noted, is also well exhibited.
Granular calcareous particles and star-shaped crystals arc found
among the contents of each capsule, and a large number of round
cells with granular opaque contents.

67. “ The liver and stomach of the rat (mus decumnnus). There are

cysts on the liver containing ci/sticercus fasciolaris. One cyst
hanging by a pedicle is observed, from which the entozoon has
extruded.” (Ewart.)

Presented by Professor Crozier.

68. “ Liver of a domestic rat ( mus deenmanus), with a cyst in its
centre from whence was extracted a taenia, — and which is append-
ed to its parent cyst. There are also two other cysts containing
remnants of similar dead worms.” (Allan Webb. — Palholoyia
Indica, No. 1S5, page 257.)

These are evidently specimens of the cysticercus facial aris, which, as Yon Siebold
and others have shown, often developes, even while encysted, into a tarnia-
likc form, but only acquires the characters of the mature taenia (T. crassi-
collis) in the intestine of the cat. J. 1A 1J. McC.

Presented by Mr. Evans.

69. Two hydatid cysts from the liver of a bullock. One contained a
limpid fluid, the other (as shown in the specimen) semi-solid,
sebaceous material. “ In both cysts a large number of scolices
with booklets, &c., were discovered on microscopic examination.”

Presented by Dr. J. Cleghorn, 10th N. I., Mooltan.

70. Portions of the lungs, liver, and heart of a flit cow. The lungs
were studded with hydatids, varying in size from that of a
pigeon’s egg to that of an orange. They possessed firm, fibrous
capsules, directly continuous with, and inseparable from, the
surrounding pulmonary tissue. Within the capsule, a large,
transparent, hyaline bladder, filled with clear limpid fluid (neutral
in reaction, and non-albuminous). In some of the tumours a
little yellowish sebaceous material intervenes between the fibrous
capsule and the akephalocyst. Some of the cysts were quite
barren, others enclosed secondary free smaller cysts and cystic
buddings from the inner surface of the mother-cyst, but all were
structureless in character, and no head or hooklets could be
detected at any part of them, or in the fluid contents.

In the heart (portion preserved) there is one hydatid cyst, the size
of a walnut, situated in the anterior wall of the right ventricle
and occupying not only its whole thickness, but projecting also'
a little into the ventricular cavity, beneath the endocardium. The
external capsule is firm, fibrous, and inseparable from the muscu-
lar tissue of the cardiac, wall. A very large amount of sebaceous-
like material is collected between it and the contained akephalo-
cyst. The contents of the latter are fluid and turbid. Under
the microscope, much fat, cliolesterine plates, epithelium, and
granular matter are found, but no hooklets. The division of
the hydatid membrane into the ekto- and endo-cyst is well
marked, and also, the laminated character of the former. The
latter appears to be barren, — contains no daughter-cysts nor
parietal sprouts.

642

FILARIA MEGASTOMA.

[series XIX.

In both the lung’s find the heart, the indurated thickened condition
of the capsule seems to have led to the death of the hydatid-
broods.

The liver contained no hydatids, but the bile-ducts are seen to be
dilated, and their walls partially calcified. Within them six
distomata (J). hepaticum ) were found, coiled upon each other,
two of which have been preserved {see prep. No. 03).

Presented by Moulvie Tameez Khan, Khan Bahadoor, Calcutta.

71. “ Oxyuris curvula from the large intestine of cquus caballus. ”

(Ewart.)

72. Four nematoid worms, each about If" in length, with a smooth,

oval-shaped, simple mouth, and a pointed caudal extremity.
Other characters not recognisable owing to long preservation in
spirit, and consequent opacity and hardening. Probably oxyuris
curvula , from the horse.

73. “ Cancer of the stomach of an Australian horse. The foreign

growth is about the size of a walnut, and situated between the
mucous and muscular tunics. Its section shows a few cavities
in its substance.” (Ewart.)

This is not a cancerous growth but a parasitic tumour, — a circumscribed
nodular hypertrophy of the glandular and submucous tissues of
the stomach of a horse, due to the irritation produced by the
presence of certain nematoid worms. On section, it is seen to be
honeycombed or alveolated, — the alveoli constituting the nests
of the entozoa. From one of them four mature filarise were
extracted, and proved on examination to be the Filaria megastoma
of Schneider ( Spiroptera megastoma of Rudolphi), — the large-
mouthed maw-worm of the horse. J. F. P. McC.

74. A similar preparation, — a nematoid tumour from the stomach of

a horse.

Presented by R. S. Hart, Esq., m.r.c.y.s., Calcutta.

75. Filaria oculi vel papillosa, removed from the eye of a small

country-bred horse. “ It was very active while in the eye, but
died almost immediately after removal.”

Presented by Dr. F. W. Hyginson, Civil Surgeon, Gonda, Oudh.

SERIES XX.]

INDEX.

613

Semes XX.

CALCULI, CONCRETIONS, AND FOREIGN
BODIES FROM THE URINARY AND DIGES-
TIVE ORGANS, AND FROM OTHER PARTS
OF THE BODY*

INDEX TO THE SERIES.

-URINARY CALCULI—

(ci) Composed chiefly of one ingredient.

1.— Principally of uric acid, 20, 37, 64, 71, 80, 95, 104, 106, 119,

2- ■ UEATE 0F ^monia, 3, 7, 31, 40, 42, 53, 58, 82,

101, 105.

3. -

4. -

OXALATE OF LIME, 12, 61, 129, 218.

7 PH0SpnATE OF AMMONIA AND MAGNESIA friUPTu-
phosphate), 136, 138, 147, 152. ' 1 ' IPLE

(b) Composed of a mixture of two or more ingredients.

!•— Dric acid and urate of ammonia, 1, 4, 6, 9, 10 11 is i-?

18 21, 23, 25, 27, 28. 29, 30, 32, 34, 35, 36, 38, 43 48 50 5l'

52, oo, 56, 57, 62, 63, 66, 72, 73, 76, 77, 78, 79, 81 83 ’ 8l’ S3

87, 88, 93, 94, 96, 97, 98, 99, 100, 111, 120, 125. 126 ’l40 14R

*13 216 229 186> 192, 195, 199, 20 J’ 203, 2o,J’ 208,’ 21 o’, 2 12,
umaiZm?-. [%*mTBOST™'ss’ u’ 19' 22’ 68>

3.-URIC ACID, URATE OF AMMONIA, PHOSPHATE, AND AMMONIO-M AGNES-
IAN PHOSPHATE, 148, 150, 187, 191, 196. ES

4- DkIC ACID, URATE OF AMMONIA, AND TRIPLE PHOSPHATE, 59.

5. — Uric acid and fusible, 161, 165, 211, 219.

6. — Uric acid and oxalate of lime, 134, 135, 137, 168, 174.

oxalate of lime, and phosphates, 160, 166, 175, 177,

8. URIC ACID, OXALATE OF LTME, AND URATE OF AMMONIA 2 5 S /fl

49. 54, 86, 89, 112, 114, 115, 116, 122, 123, 127 142, 157, ITO,’

9. — Uric acid . urate of ammonia, oxalate and phosphate of lime

iU3 10 Jj* }

* Urinary (vesical) calculi as seen in situ are described in Scries XII.

644

INDEX.

[SERIES XX.

10. — Urate of ammonia and oxalate of lime, 16, 24, 26, 33, 44, 45,

60, 65, 67, 75, 91, 103, 113, 139, 182, ISO, 200, 202, 215, 220.

11. — Urate of ammonia and phosphates, 90, 130, 145, 153, 169, 193,

223.

12. — Ueate of ammonia and fusible deposit, 39, 128, 141, 143, 144,

149, 158, 171, 184, 205.

13. — Ueate of ammonia and oxalate and phosphate of lime, 179, ISO,

181, 183, 188.

14. — Ueate of . ammonia, oxalate of lime, and fusible deposit, 185,

214, 217.

15. — Ueate of ammonia and ammonio-magnesian phosphate, 224.

16. — Oxalate of lime and phosphates, 131, 173.

17. — Oxalate of lime and teiple phosphate, 124, 221.

18. — Oxalate of lime and phosphates, and teiple phosphate, 151,

167.

19. -

20. -
21.-
22.-

23. -

24.

25.

-PnOSPHATES AND TEIPLE PHOSPHATES, 47, 164.

-PHOSPHATES, TEIPLE PHOSPHATE, AND FUSIBLE DEPOSIT, 133.

-Phosphates and fusible deposit, 132.

-Triple phosphate and fusible deposit, 163, 204.

-Calculi with traces of cystic oxide, 19, 24, 90, 100,

-Calculi, tee nucleus of wnicn consists of uric acid, 1, 5, 6,
9, 11, 13, 14, 15, 17, 18, 20, 21, 23, 25, 27, 29, 32, 34, 35, 36, 37,
38, 41, 48, 49 51, 54, 55, 59, 62, 63, 64, 68, 71, 72, 74, 76, 77,
80, 81, 83, 84, 85, 87, 92, 95, 96, 98, 99, 101, 106, 111, 112, 116,
119, 126. 134, 140, 155, 156,157, 161, 162, 165, 172, 174, 175,
176, 177, 194, 199, 206, 211, 212, 219.

-Calculi, the nucleus of which consists of urate of ammonia,
2, 3, 4, 7, 8, 10, 16, 22. 26, 28, 30, 31, 39, 40, 43, 45, 50, 52, 53,
56, 57, 58. 65, 66, 67, 69, 70, 73, 75, 78, 79. m2, 86, 88, 89, 91, 93,
94, 97, 101, 103, 105, 107, 108, 1 10, 114, 118, 120, 122, 125, 128,
130, 141 to 146, 14S, 149, 150, 153, 158, 159, 169, 171, 180, 181,
182, 181 to 193, 195, 196, 201, 202, 203, 205, 208, 209, 210, 213,
215, 216, 217, 222, 223, 224.

26.

27. — Calculi, the nucleus of wnicn consists of phosphate of

. LIME, 47, 132, 133, 136, 138, 147, 152, 163, 164, 173, 204.

28. — Calculi, with excentric nucleus, 4, 9, 25, 45, 55, 68, 86, 90,

116, 128, 178, 197.

29. — Nucleus double, 161.

30. — Nucleus formed by blood-clot, 197.

SERIES XX.]

INDEX.

645

31. — Calculi which have not been divided, and whose composition

is, therefore, undecided, 225 to 250 inclusive.

32. — Urethral calculi, 251, 252, 253, 254, 255, 256, 256a.

33. — Prostatic calculi or concretions, 257, 258 (No. 61, Series

Ail ) •

34. — Renal calculi,* 259, 260.

Calcareous concretions surrounding foreign bodies in the
BLADDER, 261, 262.

B. — BILIAEY CALCULI.

1.— Gall-stones chiefly composed of cholesterine, 263, 264, 265
266, 267. • 9

2-— Gall-stones chiefly composed of pigment-matter. 268 260
270, 271, 272, 273. ’ ’

C. — INTESTINAL CALCULI OR CONCRETIONS—

1. — From the rectum, 274, 275, 276.

D'~F0 PARTS OPThI BODY. COtfCEETIONS PIt0M OTHER
I* From the liver (a metallic pin), 277.

2. From the peritoneal cavity, 278.

From the pleural cavity, 285.

4.— Lachrymal concretions, 279, 280.

Diphtheritic (fibrinous) concretions, 281, 232, 283.

Calcareous concretion from the lung, 284.

7. — FOREIGN BOOT (PIECE OP BAMBOO) IMBEBDED „ TUB FOREARM ,

8. Encysted and impacted bullets, 287, 288.

9. -PREPARATIONS FROM THE LOWER ANIMALS, 289, 290, 291, 292, 293.

A series of calculi presented to the Museum by Rai Ram Naratn
as, Uaiiadoor, late Lecturer on Surgery to the Campbell Mr /)

Caij,t00hr?nd ■ Rrst Sur^m <o the CarnplTaowm

Calcutta, . {Descriptions taken from the Donor' s “ Monoaralh on
Lateral Lithotomy Operations," Calcutta, 1876, pp. 47

L A “Jfj1 ,0TaI calculus of a light yellowish colour, slightly tuber
culated on its external surface. It weighs 4 drachms w '
extracted successfully from a Hindu, a|ed 50 It the R,,,)
Government Dispensary, 20th January 1849. ’ “ Budaon

* Calculi in the kidneys (and ureters) as seen in situ are described in Series XI

646

VESICAL CALCULI.

[series XX.

The nucleus is of dark colour, and composed of uric acid with traces of
urate of ammonia. The surrounding laminae, of a light yellow-
ish colour, have a similar mixed chemical composition.

2. A large oval calculus, of dark brown colour, weighing 2\ ounces.

Extracted successfully from a Hindu, aged 50, on the 20th June
1849, at the Budaon Government Dispensary.

The nucleus is composed oi urate of ammonia, and the sunoundmg
laminae of uric acid variously mixed with oxalate of lime.

3. A large hour-glass-shaped calculus, ol light yellow colour, with

white deposits here and there on its surface, weighing one
ounce. Extracted successfully from a Hindu, aged 50, at the
Budaon Government Dispensary. „

The nucleus is not well defined, is soft and porous, consists of urate
of ammonia ; the surrounding laminae are more compact, ancl
have a similar chemical composition. .

4 An oval-shaped calculus, of white colour externally, weighing
9 drachms. Extracted successfully from a Mahomedan, aged 40,
at the Budaon Government Dispensary. .

The nucleus is excentric, and composed of urate of ammonia and uric
acid in about equal proportions. The surrounding and peri-
pheral layers are well defined, and have a similar composition.

r: A large, tuberculated, very hard and compact calculus, weighing

9 drachms. Removed successfully from a Hindu boy, aged 12,
at the Budaon Government Dispensary. .

The nucleus consists of uric acid with slight traces of urate of ammonia
and oxalate of lime ; the succeeding layers are unnorm and
not laminated,— are composed of oxalate of lime and urate ol

6 A rmmded, flat calculus, of brown colour, slightly granular on the
external surface, and weighing one ounce. From a Hindu,
seed 35. The operation was successful. . .

The nucleus is composed of uric acid and urate of ammonia m equal
proportions, and is porous ; the surrounding lamina; are com-
pact, and principally composed of uric acid with traces of mate
of ammonia. Budaon Government .Dispensary, 21th July 1819.
n A small oval calculus, of light yellow colour, with white deposits
here and there on its surface. Weight, 3 drachms. ,

Successfully extracted from a Hindu hoy, four years of age, at the
Budaon Government Dispensary. mrmmul

The nucleus is wholly composed of urate of ammonia The smround-
ing layers are of the same composition and well marked.

8. Two calculi, -one medium-sized, the other smalh They ai ^
light yellow colour, speckled white at the suiface. To&
weigh an ounce. From a Hindu lad, aged 16. Operation suc-
cessful. The nuclei arS of whitish colour, and composed of mate
of ammonia with oxalate of lime and uric acid. The successive

laminae have a similar composition. ,, Hlirrace,

0 A small, oval, flat calculus, minutely tuberculated on the smiace,
and weighing 4 drachms. Extracted successful y from a H ,
ao-ed 35. The nucleus is excentric, and is equally compo
u?ic acid and urate of ammonia. The surrounding part is

SEEIES XX.]

VESICAL CALCULI.

647

12.

13.

uniform, not laminated, is soft and porous, —composed entirely
of urate of ammonia.

10. A small, minutely tuberculated calculus, with another the size

of a pea, together weighing 2 drachms.

Removed successtully from a Hindu boy, six years of age, at the
Budaon Government Dispensary.

The nucleus of the larger stone is wholly composed of urate of ammonia,
and the surrounding whitish layers of uric acid and urate of
ammonia, in about equal proportions.

11. Two calculi,— one of large size, the other about that of a bean.

The former has a polished surface ; the latter is rough. They
weigh together 3| ounces. From Mahaboolah, a Mahomedan,
aged 60. Operation successful.

The nucleus of the larger stone is of dark colour, and chiefly composed
of uric acid. The surrounding laminae are well defined, have
a similar composition, but with traces also of urate of ammonia.
Two small calculi, of a light brown colour, having smooth
polished surfaces, and weighing 200 grains. From a Hindu boy’
aged 10 years, successfully operated upon at the Budaon Govern’
ment Dispensary, on the 18th September 1849. The nucleus
surrounding strata, and crust are chiefly composed of oxalate of
lime, but with traces of urate of ammonia.

A small, flat,, oval calculus, polished on its external surface, and
weighmg 60 grains. Successfully removed by operation from
a Mahomedan, aged 50.

The nucleus is porous and not well defined ; consists of uric acid with
traces of urate of ammonia, and the surrounding lamime have
the same chemical composition.

14. An oval calculus, of light brown colour, weighing ISO grains.

liom a Mahomedan, aged 30. Operation successful.

I he nucleus is of dark colour, is composed of uric acid with traces of
urate of ammonia. The surrounding strata are sharply defined
have a similar composition, and, towards the surface, traces of
phosphate of lime are found.

A small oval calculus, of light brown colour, polished on its
external surface, and weighing 40 grains.

Successfully extracted from a Hindu, aged 50. The nucleus consists
of uric acid with traces of urate of ammonia. The surrounding
layers are well defined and have a similar composition.

A moderate-sized calculus, of light brown colour externally, and
on section exhibiting darker and lighter coloured concentric
laminae It weighs 8* drachms. Was successfully removed from
a Hindu, aged 40. The nucleus is of dark colour and porous
is wholly composed of urate of ammonia; the succeeding layers
consist of urate of ammonia variously mixed with oxalate^ of
lnne, and the crust contains a larger proportion of the latter.

A large, flat, oval-shaped calculus, of light brown colour, weio-hino-
™ an<^ a Extracted successfully from a MahonTedan,

The nucleus is of dark colour, and consists chiefly of uric acid with
traces of urate of ammonia. The surrounding layers are

15.

16.

648

VESICAL CALCULI.

[SEEIES XX.

composed of uric acid and urate of ammonia in about equal
proportions.

18. A large calculus, of dark yellow colour, with white deposits on

its surface, which is smooth and polished. Weight 2| ounces.
Successfully removed by operation from a Mahomedan, aged 20.
The nucleus is of brownish colour, consists of uric acid, with slight
traces of urate of ammonia. The surrounding layers are well
marked, are composed of uric acid and urate of ammonia in
about equal proportions, and the crust of urate of ammonia
only.

19. A section of an oval-shaped calculus, of yellowish-white colour,

which, when entire, weighed an ounce and a half.

Extracted successfully from Doomah, a Mahomedan boy, aged 12 years.
Budaon Government Dispensary, 21st October 1849. The
nucleus is composed of urate ol ammonia with traces of cystic
oxide. The surrounding layers are porous and homogeneous, and
consist of urate of ammonia with uric acid, variously mixed with
phosphate of lime.

20. A compact oval calculus of large size, dark yellow in colour, its
external surface granular or tuberculated, but polished. It
weighs 14 drachms. Was successfully removed by operation from
a Hindu, aged 20.

The nucleus consists of uric acid and traces of urate of ammonia.
The surrounding laminae are well defined, and have a similar
composition. The crust is darker in colour, and chiefly made
up of uric acid.

21. A rounded calculus, of chalky colour, with a polished surface, and

weighitig 180 grains. From a Hindu boy, aged six years.
Operation successful. The nucleus consists ol uric acid with
slight traces of urate of ammonia ; the first surrounding layers
are coloured and composed of urate of ammonia, with tiaces
of uric acid ; and the succeeding layers and crust are white, and
mainly made up of urate of ammonia.

22. An oval, flat calculus, of chalky colour, and markedly tuberculated

at the surface. With it is preserved a smaller conical calculus
removed at the same operation,— which was successful.

From a Hindu boy, aged eight years. _

The nucleus of the larger stone consists of urate of ammonia; the
surrounding laminm of urate of ammonia and uric acid in about
equal proportions ; and the crust, which is whiter, contains
traces of phosphate of lime.

The calculi together weigh 180 grains.

23. A medium-sized, oval-shaped calculus, of light yellow colour,

weighing 4 drachms.

Removed successfully from a Hindu boy, aged eight years.

The nucleus consists of uric acid and urate of ammonia ; the surround-
ing rings are well marked, and mostly composed ot urate ol
ammonia, with traces of uric acid.

24. An oval, medium-sized calculus, of brownish colour externally,

weighing an ounce and a half.

From a Hindu, aged 45. Operation successful.

SERIES XX.]

VESICAL CALCULI.

649

The nucleus is composed of urate of ammonia, with traces of cystic
oxide ; the next surrounding layer of urate of ammonia variously
mixed with oxalate of lime, and containing also traces of cystic
oxide ; the peripheral layer is whitish, and made up of urate of
ammonia with oxalate of lime.

25. An irregularly ovoid calculus, weighing G drachms, extracted

successfully from a Hindu, aged 35.

The nucleus is excentric, and consists of uric acid and urate of ammonia
in equal proportions; the succeeding layers of uric acid, with only
slight traces of urate of ammonia ; the crust, whitish and porous,
has a similar chemical composition.

26. An oval-shaped calculus, of dark colour, weighing 2 ounces.

From a Hindu, aged 40. The patient died seven days after the

operation.

The nucleus is composed of urate of ammonia, and is surrounded by
layers of the same, variously mixed with oxalate of lime. This is
succeeded by a whitish lamina, consisting almost entirely of
oxalate of lime (with only traces of urate of ammonia) ; the
crust is of dark colour, and wholly composed of ammonium
urate.

27. Two small calculi ; broken during extraction. Operation successful.

From a Hindu boy, aged eight years. The nucleus and surround-
ing lamime are not distinct. I he structure is throughout soft
and friable. Both stones arc composed of uric aeid”and urate
of ammonia.

28. A large, oval, slightly flattened calculus, of light yellow colour,

a little tuberculated at the surface, and weighing 500 crrams.

From a Hindu, aged 40. The patient died thirty-six days after the
operation.

The nucleus is large, ill-defined, and porous ; consists of urate of am-
monia with uric acid. The surrounding laminae have a similar
composition, but are well marked, hard, and compact.

29. An ^ hour-glass-shaped calculus, of whitish colour externally. It

weighs 7 drachms. Extracted successfully from a Hindu bov
aged 10 years.

The nucleus consists of uric acid and urate of ammonia in about equal
proportions ; the surrounding layers of urate of ammonia with
only traces of uric acid. The constricted portion is softer, and
contains much phosphate of lime.

30. An irregularly rounded calculus, of dark brown colour, speckled

with whitish deposits on the external surface. It weighs 13
drachms. Kemoved successfully by operation from a 'Hindu
aged 35. *

The nucleus consists of urate of ammonia with slight traces of uric
acid. The next surrounding layer is of a light yellow colour
and composed of equal proportions of urate of ammonia and
une acid. The succeeding layers have a similar composition
but are not well defined towards the periphery. The larne-
sized tubercles on the crust have also the same chemical

650 VESICAL CALCULI. [series xx.

31. A large rounded calculus, of brownish colour and polished surface,

weighing 2 ounces.

From a Hindu boy, aged 10 years, who died three days after the
operation.

The nucleus is wholly composed of urate of ammonia, as also are the
next surrounding laminae. The peripheral layers contain slight
traces of uric acid.

32. A compact hard calculus, of dark brown colour, weighing 120

grains.

Extracted successfully from a Hindu boy, aged five years.

The nucleus is double, of dark colour, and consists of uric acid with
traces of urate of ammonia ; the surrounding laminae, on the
contrary, are composed chiefly of urate of ammonia, with but
traces of uric acid.

33. A flat oval calculus of yellowisli-white colour, weighing an ounce.
Removed successfully from Heerah, a Hindu, aged 35.

The nucleus is of dark colour, and chiefly composed of oxalate of lime.
The concentric rings are well marked, and are made up of oxalate
of lime and urate of ammonia.

34. An oval-sliaped calculus, of light yellow colour, weighing 4

drachms.

Successfully extracted from a Hindu boy, eight years of age.

The nucleus and surrounding layers are well marked, and composed of
uric acid and urate of ammonia in about equal proportions.

35. An oval flat calculus, of light yellow colour, and granular surface,

weighing 150 grains.

From a Hindu boy, aged 10. Operation successful.

The nucleus is not well marked, the whole of the structure is porous,
and the stone throughout is composed of uric acid and urate
of ammonia.

36. A medium-sized rounded calculus, of light yellow colour externally,

weighing 100 grains.

Extracted successfully from a Hindu, named Urjoon, eight years of age.
The nucleus consists of uric acid and urate of ammonia in about equal
proportions. The surrounding layers are porous, and entirely
composed of urate of ammonia.

37. A medium-sized calculus, soft in texture, and broken during

extraction. It weighs 2 drachms. The patient was a Mahomed-
an, aged GO. He died on the thirteenth day after the
operation.

The nucleus and next concentric layers are well defined, the rest is
uniformly porous. Every part of the stone is composed of
uric acid with traces of urate of ammonia.

38. A slightly tuberculated calculus, of light brown colour, weighing

5 drachms.

Extracted successfully from a Mahomedan, aged 40. Budaon Govern-
ment Dispensary, 23rd April 1850.

The nucleus is of brownish colour, porous, and consists of uric acid and
urate of ammonia in about equal proportions. The succeeding
layers, including the thick and whitish crust, have a similar
composition.

SEEIES XX.]

VESICAL CALCULI.

651

39. A rounded calculus, of whitish colour externally, and slightly

granular surface. It weighs an ounce and a half.

Successfully removed by operation from a Hindu, aged 20.

The nucleus consists of urate of ammonia with slight traces of uric
acid ; the next coloured rings or layers are well marked, and
have a similar composition. The outer thick and white crust
is porous and crystalline ; is made up of urate of ammonia,
triple phosphate, and phosphate of lime.

40. A flat oval-shaped calculus, markedly tuberculated on the surface.
It weighs an ounce.

From a Mahomedan, aged 45. Operation successful. The nucleus
is large and porous, and entirely composed of urate of ammonia.
The surrounding lamime contain urate of ammonia with traces
of uric acid ; and the tubercles on the surface have a similar
chemical composition.

41. A small calculus, of light yellow colour, with white deposits on

the surface,— weighing 180 grains. Extracted successfully from
a Hindu boy, aged 10. The nucleus is not well defined, and the
general structure is porous and white, — not laminated.

Every part is composed of uric acid, with traces of urate of ammonia
and oxalate of lime.

42. A moderately large, somewhat heart-shaped calculus, with a
slightly tuberculated surface,— weighing 4£ drachms. From a
Mahomedan, aged 40. Operation successful.

The nucleus is ill-defined, the general structure porous,— not laminated ;
it is almost entirely composed of urate of ammonia.

43. A. compact oval-shaped calculus, of a dark colour externally, and

weighing 270 grains. Successfully removed by operation from a
Hindu lad, aged 15.

The nucleus is entirely composed of urate of ammonia, and the surround-
ing layers, which are well marked, of uric acid and urate of
ammonia about equally.

44. A medium-sized oval calculus, of brownish-white colour, wemhincr

G drachms. 5 b

Removed successfully from a Hindu bey, aged 10 years. The nucleus
is chiefly composed of oxalate of lime with traces of urate of
ammonia ; the succeeding layers, including the crust, of urate of
ammonia with a small amount of calcium oxalate.

45. A flat oval calculus, ol light brown colour externally, weierhim?

4 drachms. J fa b

Successfully removed by operation from a Hindu lad, aged 14 years.

The nucleus is excentric, and is composed of urate of ammonia variously
mixed with oxalate of lime. The surrounding layers are porous
principally consist of urate of ammonia, but contain traces of
uric acid and oxalate of lime.

46. A medium-sized oval calculus, weighing G drachms. Extracted

successfully from Kaneah, a Hindu boy, aged 10 years.

The nucleus consists chiefly of oxalate of lime, variously mixed with
lithate of ammonia and lithic acid. The first and second con-
centric rings have the same chemical composition. The peripheral

VESICAL CALCULI.

G52

[semes XX.

layer or crust is made up of lithate of ammonia and litliic acid,
with only traces of oxalate of lime.

47. A large irregular-shaped calculus, of a white colour externally,

weighing d ounces.

Successfully extracted from a Hindu, aged 50. Budaon Government
Dispensary, 23rd July 1850.

The nucleus is almost entirely composed of phosphate of lime, with
traces of triple phosphate. The internal structure generally
is polished, of a white marble-like appearance, has the same
chemical composition, but with traces of urate of ammonia.

48. Two calculi, — one large, the other small. Both are of triangular

shape, and chalky colour, and together weigh 500 grains.

They were successfully removed by operation (at the same time) from a
Hindu, aged 35. Their chemical composition is the same, viz.,
a nucleus consisting of about equal proportions of lithic acid
and lithate of ammonia, and surrounding layers of chiefly
lithic acid.

49. An oval calculus, of light yellow colour, weighing 7 drachms.

From a Mahomedan boy, aged 10 years. Operation successful.

The nucleus and surrounding coloured laminae are composed of uric
acid and urate of ammonia in about equal proportions. The
peripheral layers are white, and, with the crust, made up of urate
of ammonia, traces of uric acid, and oxalate of lime.

50. A small, flat, oval calculus, slightly granular on the surface, weigh-
ing 50 grains. Extracted successfully from a Hindu, aged 50.

The nucleus is well defined, and consists of urate of ammonia. It is
surrounded by dark rings of the same material, but with traces
of uric acid. The crust is composed of urate of ammonia and
uric acid in about equal proportions.

51. A filbert-shaped rough-surfaced calculus, weighing 65 grains.

From a Hindu boy, aged eight years. Operation successful.

The nucleus is distinct and surrounded by porous layers. They are
composed of lithic acid and lithate of ammonia.

52. A large calculus, of light brownish colour externally, and slightly

granular on the surface. It weighs 2 ounces 3£ drachms.
Extracted successfully from a Hindu, aged 50. Budaon Government
Dispensary, 15th May 1851.

The nucleus consists entirely of urate of ammonia ; the next surrounding
layer is porous ; this, and the succeeding layers, are composed of
urate of ammonia mixed in varying proportions with uric acid.

53. A small rounded calculus, of light yellow colour externally, and

weighing 130 grains. From a Hindu boy, aged six years.
Operation successful.

The nucleus is well marked and of yellowish colour, consists of urate
of ammonia with traces of uric acid, and the surrounding rings
have a similar chemical composition.

54. A rounded calculus, of light brown colour, weighing 250 grains.

Successfully extracted from a Hindu boy, aged five years.

The nucleus is mostly composed of uric acid, but with traces of
urate of ammonia and oxalate of lime. The surrounding rings are
porous, and consist of urate of ammonia and traces of uric acid.

SEEIES XX.]

VESICAL CALCULI.

653

57.

58.

55. A small oval calculus, of light brown colour, weighing 40 grains.
Extracted successfully from a Hindu boy, 10 years of age The

nucleus is excentric, and of a whitish colour. It is surrounded
by a dark lamina, to which succeeds porous whitish material, and
finally, a hard compact crust ol light brown colour. All of them
are composed of uric acid with traces of urate of ammonia.

56. A small rounded calculus, of light brown colour externally. It

lias a little pedicle or attached process, like the stalk of a
cherry. Weight, 120 grains.

From a Hindu boy, aged four years, who died seven days after the opera-

The nucleus is soft and porous, consists of urate of ammonia and uric
acid in about equal proportions. The surrounding lamina? are
winter, but have a similar composition.

An oval calculus, of brown colour, markedly tubercuiated on the
surface and weighing 110 grains. Extracted successful! v from
a Hindu boy, seven years of age.

The nucleus is chiefly composed of urate of ammonia with traces of

anL™«lLt^fSUTUnrlnS stru.cture is Poro“s> not laminated,
proportion^ ammoma and uric acid in about equal

A small rounded calculus, of dark brown colour, and minutely
tubercuiated at the surface. It weighs 110 grains
From a Hindu, aged 30. Operation successful.

e nucleus, of dark colour, consists entirely of urate of ammonia •
the surrounding layers are uniform and porous, are composed of
c urato amrponia with traces of uric acid

59' wigb!ngd05tain,Cal°UlUS’ °f ^

Extracted successfully from a Hindu boy, eight years of a-e Thp
nucleus is somewhat hour-glass-shaped, of dark colour, and com
posed of uric acid and urate of ammonia. The surrounding
layers are white, porous, not laminated, and made up of urate of
ammonia and triple phosphate in about equal proportions

cuhtedUmi'tS1+hd oval ealcuIus> of brownish colour, markedly tuber-
eulated at the surface, and weighing G drachms ,

successfully by operation from a Hindu, aged 20 ^

The nucleus .s clnclly composed of oxalate of limn, but with traces of

— *

ammonia °' with sliS'“ traces of" ffihatftf

ftom'r na^08r Tire nucleus is well
defined, consists of oxalate of lfmc with traces of urate •

SST-f -- — ■» ^ -US

"on'S^ eolom externa,, y, >igh,ye,Iow

SZ im"4' **

60.

61.

62.

654

VESICAL CALCULI.

[SEEIES XX.

The nucleus is not well marked, is large and porous, consists of uric acid
and urate of ammonia in equal proportions. The surrounding
layers are hard and compact, have a similar chemical com-
position.

63. A moderately large, yellowish-coloured calculus, with patches of

white deposit on its surface. It weighs 10 drachms.

From a Hindu, aged 50, who died three days after the operation.

The nucleus, of dark colour, is composed of uric acid and urate of
ammonia. The surrounding coloured laminae and crust have a
similar composition.

64. A small oval calculus, of light brown colour, weighing 120 grains.

liemoved successfully from a Mahomedan boy, aged 10 years.
The nucleus and surrounding layers have the same chemical
composition — viz., uric acid with traces of urate of ammonia.

65. A small oval tuberculated calculus, weighing 3 drachms. Success-

fully removed from a Hindu boy, six years of age. The nucleus
is chiefly composed of lithate of ammonia containing traces
of calcium oxalate ; the next surrounding rings are well marked,
and have a similar composition ; the “ third layer ” is ill-defined,
and almost wholly composed of calcium oxalate ; the crust is
white, and, besides the oxalate, contains traces of lithate of
ammonia.

66. A large oval calculus, of light yellow colour, tuberculated at
the surface. It weighs 14 drachms. Extracted successfully
from a Hindu, aged 30. There is no definite nucleus ; the
stone is homogeneous and porous throughout ; it is composed of
urate of ammonia and uric acid.

67. An oval- shaped calculus, of brownish colour, weighing 125 grains.

Successfully extracted from a Hindu, aged 50. The nucleus is
large and somewhat dark. Consists of lithate of ammonia. The
crust is whitish on section, and has a similar composition, but
with traces of oxalate of lime. The intermediate dark lamina
contains oxalate of lime principally, with only traces of lithate
of ammonia.

68 A pyriform calculus, of light brown colour externally, minutely
granulated on the surface, and weighing 195 grains. From a
Hindu, aged 30. Operation successful. The nucleus is porous
and excentric, consists of uric acid with traces of urate of
ammonia. The surrounding laminae and “base ” are whitish, smooth,
not laminated ; are composed of urate of ammonia with traces of j
uric acid and calcium phosphate.

69. A rounded fiat calculus, of light yellow colour externally, and |

minutely tuberculated on the surface. It weighs 190 grains. Suc-
cessfully extracted from a Hindu, aged 35. The nucleus consists
of urate of ammonia and uric acid in about equal proportions.
The surrounding layers and crust are composed of urate of
ammonia with traces of phosphate of lime.

70. A medium-sized calculus, of rounded shape, and “amber” colour,
weighing 7 drachms. Successfully extracted from a Hindu lad
15 years of age.

SERIES XX.]

VESICAL CALCULI.

655

The

72.

The nucleus consists of lithate of ammonia with traces of litliic acid.
rlhe next surrounding layer is not laminated; those which
succeed are markedly so, are of chalky appearance, of similar
composition to the nucleus, but with traces of oxalate of lime.
I he whitish crust has, in addition, an admixture of lithic acid
and phosphate of lime.

71* A large, tuberculated but polished calculus, of a brownish colour
weighing 3 ounces 6 drachms.

Extracted successfully from a Hindu, aged 30, at the 13udaon Govern-
ment Dispensary, 4th August 1851.
nucleus is white, composed of uric acid with traces of urate of
ammonia; the surrounding darker laminae, which become separ-
ated on section, have a similar chemical composition.

A small ovoid calculus, minutely tuberculated on the surface, and
weighing 40 grains.

Removed successfully from a Hindu boy, three years of age.

I he nucleus is distinct and hollow ; the surrounding layers well marked •
the whole stone consists of lithic acid and lithate of ammonia ’
16. A large calculus, of oblong shape, markedly tuberculated on the
surface, of light brown colour, and weighing 3 ounces 5 drachms.
Extracted from Ham Ram, a Hindu, aged 35, who died on the eighteenth
day after the operation. The nucleus is entirely composed of
lit-iate of ammonia ; the next surrounding layer is porous, and,
together witn tlrn last layer, is composed of equal proportions of
lithate of ammonia and lithic acid. 1

74. A large oval calculus, of chalky colour externally, and weighing
2 ounces 7 drachms. ° »

Removed successfully by operation from a Mahomedan lad, a<red 15
Ihe nucleus consrsts of uric acid with traces of urate of ammonia the
surrounding coloured layers have the same composition'- the
crust is made up of phosphate of lime with traces of urate of

Aing 4 d?aVchmsalCUl“S’ °f recldish-brow“ externally, weigh-

Extracted successfully from a Hindu, aged 40

The nucleus is composed of lithate of ammonia and oxalate of lime in

equal proportions ; the next surrounding lamina of dark-brown
colour, consists, entirely of lithate of ammonia ; the perinheS

and oxalate^of iime “d C0"P°SeJ °f lithate °f
A large calculus, of somewhat triangular shape, and dark-brown
co our, with whitish superficial deposits. It is granular but

polished, and weighs 2 ounces 6 drachms. bUt

op^raTom * ^ 5°’ Wh° died eight da?s a£ter the

The nucleus is porous, consists of uric acid and urate of ammonia in

andalfvpP° 0niS‘ The surroundinS laJers are not well defined
and nave a similar composition. ’

A medium-sized calculus a little curved on one side, pointed
at one end, of chalky colour, and weighing 4 drachms.

75.

76.

From

77.

050

VESICAL CALCULI.

[series XX.

The nucleus ancl surrounding laminae are of a light yellow colour, and
composed of uric acid and urate of ammonia. The white layer
on one side consists entirely of urate of ammonia.

78. A small, rounded, and minutely tuberculated calculus, weighing

GO grains.

Extracted successfully from a Maliomedan, aged 25. The nucleus is
porous and entirely composed of urate of ammonia; the surround-
ing white layer of uric acid and urate of ammonia.

79. A large oval polished calculus, of dark brown colour, and

weighing 2 ounces.

o o

Successfully extracted from Bucktee, a Hindu, aged 30, at the Budaon
Government Dispensary, 25th August 1851.

The nucleus is of dark colour, and consists entirely of urate of ammonia ;
the surrounding lamime are well marked, and have a similar
composition ; the crust is whitish and made up ecpially of urate
of ammonia and uric acid.

80. Four calculi, each about the size of a pigeon’s egg, and twenty-
three smaller ones ; all with polished, smooth surfaces, and
together weighing 7 drachms.

Successfully removed by operation from a Hindu, aged 50.

One of the larger stones has been bisected. The nucleus and surround-
ing laminae are well defined, and composed of uric acid with
traces of urate of ammonia.

81. A large flat calculus, of a light brownish colour, slightly tuber-

eulated at the circumference only, and weighing 2 ounces.

Extracted successfully from a Hindu, aged 10.

The nucleus is chiefly composed of uric acid with traces of urate of
ammonia. The next surrounding layers of the same, but in
about equal proportions ; and the crust, which is porous, has the
same chemical composition.

82. A rounded calculus, of light yellowish colour, minutely granular

on the surface, and weighing 330 grains. Successfully extracted
from a Mahomedan boy, eight years of age.

The nucleus is distinct ; consists entirely of lithate of ammonia ; the
next surrounding layers have the same composition ; the peri-
pheral layer or crust contains, in addition, traces of uric acid.

8a a medium-sized calculus, of somewhat triangular shape, light
yellow colour, minutely granular surface, and weighing 110 grains.

From a Hindu boy, aged eight years. Operation successful.

The nucleus is well defined, consists of uric acid and urate of ammonia
in about equal proportions. The surrounding lamime are. com-
pact and hard ; the crust porous ; they are composed of uric acid
with slight traces of urate of ammonia.

84. A medium-sized calculus, of oval shape, of chalky colour exter-
nally, granular on the surface, and weighing 310 grains.

Successfully extracted from a Hindu boy, aged 12 years. .

The nucleus is almost entirely composed of uric acid, but with slight
traces of urate of ammonia. The surrounding layers are smooth,
uniformly porous, and consist of urate of ammonia with traces of
uric acid ; the peripheral dark lamina is also composed of uric
acid and urate of ammonia.

"SERIES XX.]

VESICAL CALCULI.

657

85. A rounded calculus, of chalky colour, markedly tuberculatcd on

the surface and weighing 0 drachms.

Extracted successfully from a Mahomedan lad, aged 15.

The nucleus is composed of lithic acid and lithate of ammonia in about
equal proportions, and the concentric rings, which are well
marked, have a similar chemical composition.

86. A large oval calculus, of light-brown colour, weighing 14 drachms.
Successfully removed by operation from Indur Sing, a Hindu, aged 45.

Budaon Government Dispensary, 12th September 1851.

The nucleus is excentric and porous ; is composed of urate of ammonia
and uric acid in equal proportions, and contains traces of oxalate
of lime. The surrounding layers are porous, and have a similar
chemical composition.

87. An oval calculus, of light yellow colour, and weighing 220

grains.

From a Hindu boy, seven years of age. Operation successful.

The nucleus consists principally of uric acid with slight traces of
urate of ammonia. The surrounding rings are well marked, of
light-yellow colour, and composed of uric acid and urate of
ammonia in about equal proportions. The crust is of slate-
colour, and wholly made up of urate of ammonia.

88. Two calculi of equal size, flat, and oval-shaped. They have a
light-brown colour, and together weigh 5 drachms.

Successfully extracted from a Mahomedan, aged 50.

I he nucleus is slightly excentric, and composed entirely of ui’ato of
ammonia. The surrounding laminae, of pale yellowish colour,
consist of urate of ammonia with traces of uric acid. The
peripheral layer, of whiter appearance, has the same chemical
composition.

90.

They

89. An oval calculus, of light brown colour, with whitish deposits on
the surface. It is markedly tuberculated at both ends, and
weighs an ounce and a half.

Extracted successfully from a Hindu, aged 35.

The nucleus and coloured ring surrounding it are composed of urate of
ammonia, with traces of uric acid and oxalate of lime. The
succeeding layers are chiefly composed of urate of ammonia.

A long oval calculus, a little curved on one side. It is of a
white marble-like colour and smoothness externally. With it
a small rounded stone, of the same general appearance,
weigh together 14 drachms.

Successfully extracted from a Hindu, asred 35.

The nucleus is excentric, and consists of urate of ammonia with
traces of cystic oxide. The chalky portion below the nucleus
is composed entirely of phosphate of lime.

91. A large oval calculus, of deep brown colour, with a minutely

granulated but polished surface, and weighing 2 ounces.

From a Hindu lad, aged 16. Operation successful.

The nucleus consists of urate of ammonia with traces of oxalate of lime.
The surrounding laminae are variously composed of the samn
ingredients. u

92. A small rough calculus, weighing 120 o-rainSi

658

VESICAL CALCULI.

[SEEIES XX.

Extracted successfully from a Hindu boy, aged five years.

The nucleus is distinct, and consists of uric acid with traces of urate of
ammonia. The surrounding layers are Avell marked, and have a
similar composition. The crust contains uric acid, with traces
of phosphate of lime.

93. A small, markedly tuberculated calculus, of yellowish-white colour,

and weighing 120 grains.

From a Hindu boy, 10 years of age. Operation successful.

The nucleus is entirely composed of urate of ammonia. The surround-
ing layers are not well laminated, and consist of urate of
ammonia and uric acid in equal proportions.

94. A small, oval, minutely tuberculated calculus, weighing 45

grains.

Successfuly removed by operation from a Hindu boy, six years of age.

The nucleus is of a whitish colour, and surrounded by a porous layer ;
both are composed of urate of ammonia and uric acid.

95. A small oval calculus, of light-yellow colour, weighing 150 grains.
Extracted successfully from a Hindu boy, eight years of age. The

nucleus consists of uric acid and urate of ammonia, and the
surrounding layers of uric acid chiefly.

96. A small calculus, of chalky colour, weighing 35 grains.

From a Hindu boy, six years old. Operation successful.

The nucleus is equally composed of uric acid and urate of ammonia ;
the surrounding part is porous, exceedingly friable, and consists
of urate of ammonia with traces of uric acid.

97. A flat, oval calculus, of light yellow colour, weighing 120

grains.

Extracted successfully from a Hindu, aged 35.

The nucleus is composed of urate of ammonia and uric acid. The
surrounding layers are uniform and porous, not laminated.
They are composed of uric acid with traces of urate of
ammonia.

98. A small calculus, of yellowish-white colour, slightly granular on

the surface, and weighing 120 grains.

From Bullah, a Hindu boy, aged eight years. Operation successful.

The nucleus consists of lithic acid and lithate of ammonia in about
equal proportions ; the surrounding laminae are wholly composed
of lithate of ammonia.

99. A small, oval, laminated calculus, weighing 120 grains.

Successfully removed by operation from a Hindu boy, 10 years of age.
The nucleus and concentric rings are composed ol uric acid and urate

of ammonia in about equal proportions.

100. A large oval calculus, a little depressed at the centre, of
yellowish colour, and polished surface, weighing 14^ drachms.

Extracted successfully from a Hindu boy, eight years of age. Eudaon
Government Dispensary, 10th December 1851.

The nucleus consists of urate of ammonia, containing traces of cystic
oxide. The surrounding laminae are well marked, and variously
composed of urate of ammonia and uric acid.

101. A small round calculus, of light-brown colour, weighing 40
grains.

SERIES XX.]

VESICAL CALCULI.

Successfully extracted from a Hindu boy, six years of age.

The nucleus is entirely composed of urate of ammonia. The surround-
ing rings are well marked, have a similar composition, but with
traces of uric acid.

102. A small oval calculus, of whitish colour, weighing 150 grains.

Extracted successfully from a Hindu boy, six years of age.

The nucleus is variously composed— of oxalate of lime, urate of
ammonia, and uric acid. The surrounding layers are made up of
urate of ammonia and uric acid, but contain no oxalate of lime.

103. A small, yellowish-coloured, rough calculus, weighing 100
grains.

Removed successfully by operation from a Hindu boy, aged five years.

The nucleus and surrounding rings are well marked, and composed of
urate of ammonia with traces of oxalate of lime.

104. A large oval-shaped calculus, of white colour externally, irregu-
larly tuberculated on the surface, and weighing 10£ drachms.
Successfully removed by operation from a Hindu boy, eight
years of age.

The nucleus consists almost entirely of lithic acid, but gives slio-ht
traces of lithate of ammonia. The surrounding white layer has
a similar composition.

105. A small rounded calculus, of amber colour externally, and
with a minutely tuberculated surface. It weighs 120 drains.
Extracted successfully from a Hindu boy, four years of a<n^ The
nucleus consists of urate of ammonia. The surrounding5 yellow-
ish and darker layers have the same chemical composition

106. A small oval calculus, of light brown colour; the surface
minutely granulated but polished. It weighs 90 grains. Success-
fully extracted from a Hindu boy, five years of age. The
nucleus is distinct and surrounded by a porous layer; both are
composed of uric acid with traces of urate of ammonia.

107. A large rough oval calculus, chalky in colour, and polished on
its external surface. It weighs 6£ drachms. Successfully re-
moved by operation from a Hindu, aged 35.

The nucleus is of dark colour, and consists of urate of ammonia and
uric acid, with traces of phosphate of lime. The succeeding
laminae are principally composed of urate of ammonia.

108. A somewhat hour-glass shaped calculus, of chalky colour, and
a smaller calculus, of oval shape, and of the same colour
together weighing 2 ounces and 40 grains. Removed success-
fully by operation from a Hindu, aged 30.

1 he nucleus consists of urate of ammonia with traces of uric acid
The next concentric layers have a similar composition. The
peripheral white layer is porous, and made up of phosphate of lime
tuple phosphate, and urate of ammonia variously mixed.

109. A medium-sized rounded calculus, of light brown colour

weighing 3 drachms. From Rajah, a Hindu, aged 50. Ooeri-
tion successful. A

of ammonia and lithic acid. The surrounding * layers
of urate of ammonia and uric acid, but no oxalate of lime.

GOO VESICAL CALCULI. [seeies xx.

110. An oval flat calculus, of light brown colour, weighing 6 drachms
and 20 grains.

Extracted successfully from a Hindu, aged 40.

The nucleus is not defined, the whole stone is porous, and is composed
of lithate of ammonia containing traces of oxalate of lime.

111. A small, rough, rounded calculus, weighing G5 grains.

Successfully extracted from a Hindu hoy, six years of age.

The nucleus is composed of uric acid and urate of ammonia in about
equal proportions. The surrounding rings are porous, not well
defined, and have the same chemical composition.

112. An oval-shaped calculus, of light brown colour, weighing 4
drachms 45 grains.

Successfully removed by operation from a Hindu, aged 30.

The nucleus, of dark colour, consists of uric acid, with traces of urate of
ammonia and oxalate of lime. The surrounding layers, of light
brown colour, consist chiefly of oxalate of lime, with traces of
urate of ammonia and uric acid.

113. A medium-sized oval calculus, of a brownish colour, weighing
6 drachms.

Extracted successfully from a Mahomedan lad, aged 12 years.

The nucleus consists of oxalate of lime, and the surrounding layers of
lithate of ammonia variously mixed with oxalate of lime.

114. A rounded calculus, of light brown colour, with a polished
surface, and weighing one ounce.

Successfully extracted from a Hindu, aged 35.

The nucleus is composed of urate of ammonia with traces of uric acid
and oxalate of lime; the next surrounding layer of urate of
ammonia with more oxalate of lime and less uric acid than
the nucleus ; the succeeding layers of urate of ammonia and
varying proportions of oxalate of lime ; the crust of equal
proportions of urate of ammonia and uric acid.

115. A medium-sized oval calculus, of light yellow colour externally,
darker on section, and weighing 310 grains.

From Durmah, a Hindu, aged 35. Operation successful.

The nucleus consists of oxalate of lime with traces of urate of ammonia.
The surrounding layers are knotted and porous, and composed
of urate of ammonia, uric acid, and traces of oxalate of lime.

116. A rounded calculus, of white colour externally, and weighing
390 grains.

From a Hindu, aged 20. Operation successful.

The nucleus is excentric, and composed of uric acid, urate of ammonia,
and traces of oxalate of lime. The surrounding laminae consist
of urate of ammonia variously mixed with oxalate of lime.

117. A small, flattened, oval-shaped calculus, weighing 2 drachms, with
fragments of a second smaller stone, — both successfully removed
by one operation from a Hindu boy, aged 12 years.

The larger stone has been preserved entire. The smaller seems to have
consisted of a nucleus of uric acid, and a chalky crust of phos-
phates (fusible).

118. Three calcuii, weighing together 225 grains. One is moderately
large, the other two are small, and each is invested by a thick

SERIES XX.]

VESICAL CALCULI.

661

chalky crust, which separates oil section, leaving polished smooth
stones.

Extracted successfully from a Hindu boy, aged 10 years.

The nuclei are entirely composed of urate of ammonia ; the surrounding
laminae, which are distinctly marked, of equal proportions of
urate of ammonia and uric acid ; the external thick crusts
contain phosphate of lime in abundance, and also urate of ammonia
and uric acid in about equal proportions.

119. An oval, flat, calculus, of a chalky colour externally, brownish on
section, and weighing 110 grains.

Successfully extracted from a Hindu, aged 40. The nucleus, of dark
colour, is chiefly composed of uric acid, but contains traces of
urate of ammonia. The next concentric laminae have a similar
composition ; and the crust, though chalky in colour, is also
similarly composed.

120. An oval calculus, of light yellow colour, and tuberculated on the
surface. It weighs G drachms.

Removed successfully by operation from a Hindu boy, aged 10 years.

The nucleus is porous, _ and consists of equal proportions of urate of
ammonia and uric acid, and the surrounding layers, also porous
have the same chemical composition.

121. Two small, smooth-surfaced calculi, together wei^hin" 4 drachms

Successfully extracted from a Hindu, aged 30.

The crust of the smaller stone has been much broken up ; that of the
larger is only fissured ; neither have been divided, but the
chemical composition seems to be almost purely uric acid.

122. A rounded calculus, weighing 3 drachms.

Extracted successfully from a Hindu boy, 10 years of ame.

The nucleus is composed of urate of ammonia and uric acid. The
surrounding structure, not well laminated, has a similar com-
position, but with a variable admixture of oxalate of lime.

A series of Calculi presented to the Museum ly Dr. Wise, Civil

Surgeon, Dacca.*

123. An elongated, oval-shaped calculus of brownish colour, and with
a rough tuberculated surface. It weighs 3 ounces 6i drachms.

From a Bengali, aged 30. Duration 10 years. Result — cured.

lhe nucleus is small and slate-coloured, consists of oxalate of lime

the surrounding structure of alternating rings of urates and uric
acid.

124. A very fine specimen of “ mulberry ” calculus, weighing 2 ounces
4 drachms and 20 grains.

From a Mahomedan, aged Gl. Duration -16 years. Result— “ ceased
to attend.”

The nucleus is large, hard, and oval-shaped. The surrounding layers
are more porous. They are composed almost entirely of calcium
oxalate. The outer surface is dusted over with minute crystals
of triple phosphate.

Calcutta miCally analysed by Dr- C. J. U. Warden, Professor of Chemistry, Medical College,

6('v2 VESICAL CALCULI. [series xx.

125 An oval-shaped, rough calculus, having a pinkish tinge on
section, and weighing ounce.

It consists of urates and uric acid in alternating layers.

From a Mahomedan, aged 50. Duration — three years. Result — cured.

126. A large oval calculus and a smaller kidney-shaped one, weighing
together 3 ouncess 1 drachm 34 grains.

From a Hindu, aged 60 Duration -two years. Result — cured,

It is whitish on the surface, brown and laminated on section. The
nucleus consists of uric acid, the surrounding layers of urates
and uric acid.

127. An oval calculus, of a brownish-red colour, markedly tuberculated
at the surface, and beautifully laminated on section. It weighs
6 drachms.

From a Bengali, aged 48. Duration — four years. Result — cured.

The nucleus is hard and dark, consists of calcic oxalate. The concentric
rings are comp sed of urates and uric acid.

128. A somewhat reniform large calculus, rough and chalky-lookmg
at the surface, and weighing 2 ounces and 3 drachms.

From a Hindu, aged 40. Duration — five years. Result — died.

The nucleus is excentric. and of slaty colour ; consists of urate of ammonia.
The rest of the stone is soft and porous, and composed of triple
phosphate and phosphate of lime (fusible).

129. A very fine specimen of mulberry calculus, of medium size,
weighing 5^ drachms.

From Sobha (native male), aged 50. Duration — four years. Result-
cured.

Chemical composition — oxalate of lime.

130. A medium-sized oval calculus, with a finely granular surface,
and chalky crust. It weighs 6 drachms.

The nucleus and next concentric layers have a pinkish-brown colour, and
are composed of urates; the white crust of phosphate of lime;
at the surface minute crystals of triple phosphate are deposited
in great abundance.

From a Hindu, aged 30. Duration — 18 months. Result — cured.

131. A hard, oval calculus, with a rough surface, and of brownish
colour. Weight — 7 ^ drachms.

The nucleus is irregular, consists of calcium oxalate ; the rest of the
stone of alternating layers of the oxalate and phosphate of lime.

From a Mahomedan boy, aged eight years. Duration — one year.

Result — cured.

132. A pyriform calculus, of a chalky colour and consistencjg weighing
6 drachms 20 grains.

From a native male, aged 45. Duration — six years. Result —cured.

The nucleus is ill-defined ; the next layers slightly laminated ; the rest
smooth and homogeneous. Chemical composition — phosphate of
lime, triple phosphate and phosphate of lime (fusible calculus).

133. An oval-shaped calculus, of brownish yellow colour externally,
chalky on section. The surface is irregularly roughened.
Weight — 6 drachms.

Ihe nucleus is small and irregular, consists of phosphate of lime.
The rest of the stone is composed of triple phosphate and

sebies xs.] VESICAL CALCULI. 6C3

phosphate of lime (fusible). Large crystals of triple phosphate
are diffusely scattered over the surface.

From a Mahomedan, aged 41. Duration — 5 years. Result — died.

134. An irregularly rounded calculus, with a rough, tuberculated
surface, and yellowish colour ; weighs a little over 4 drachms.

From a Hindu boy, aged G years. Duration — 18 months. Result —
cured.

Chemical composition— -nucleus uric acid; next oxalate of lime; crust
uric acid.

135. An oval-shaped, brownish calculus, with a rough surface, and
finely laminated structure. Weight — 5| drachms.

The nucleus has a bluish tinge and hard consistency, is composed of
oxalate of lime ; the surrounding laminae of uric acid.

136. Two calculi — one large, irregular shaped, flattened on one side
and rough, polished and convex on the other ; the smaller stone
is flat and polished. They weigh together 5 ounces 2\ drachms.
The larger calculus is coarsely and loosely laminated, of a
chalky-white colour, and chemically fusible (triple phosphate
and phosphate of lime). No history.

137. A medium-sized calculus, with a chocolate-coloured and polished
surface; weighs G drachms.

From a Hindu, aged 20. Duration — 10 years. Result— cured.

The nucleus is large, of dark-brown colour, and composed of calcium
oxalate ; the rest of the stone of uric acid and calcium oxalate
in alternating layers.

A series of Calculi presented to the Museum by Assistant- Surgeon
Abinas Chunder Gupta, Pertabgarh*

138. A rounded calculus, of chalky-colour, and rough surface,
weighing 6£ drachms.

The nucleus is not well defined, and the whole structure of the stone
is more or less porous. It consists of triple phosphate and
phosphate of lime (fusible).

139. A large rounded calculus, with an imperfect chalky crust. It
weighs 2 ounces 7\ drachms.

The nucleus is well defined and hard ; consists of oxalate of lime.
The succeeding layers are smooth, and composed of urates ;
the peripheral layers are delicately laminated, and composed
of oxalate of lime and urate of ammonia in varying proportions.

140. An elongated oval calculus, weighing a little over G drachms*

The nucleus is irregular, and composed of uric acid, the rest of the

stone of urates.

The central layers are porous, the peripheral hard and compact

141. A similar shaped calculus, with a porous chalky crust. It
weighs 5 1 drachms.

The nucleus is not well defined ; consists of urate of ammonia ; the
rest of the stone is fusible.

* Chemically analysed by Dr. C. J. H. Warden. Professor of Chemistry, Medical College
Calcutta. 6 *

664

VESICAL CALCULI.

[SEEIE8 XX.

142. A dumb-bell-shaped highly tuberculated calculus, presenting
a coral-like appearance externally, and a beautifully laminated
structure on section. It weighs 4| drachms.

The nucleus is large and porous, is composed of urate of ammonia,
the next layer of uric acid, the third of oxalate of lime ; the
last two substances, in alternate layers, make up the rest of
the stone.

143. A medium-sized oval calculus, of chalky-white colour, weighing
4 1 drachms.

The nucleus is not well defined ; the succeeding layers are delicately
laminated ; the crust soft and porous. With the exception of
the nucleus, composed of “ urates,” the stone is fusible (triple
phosphate and phosphate of lime).

144. A larger but otherwise similar calculus, weighing 7 drachms
20 grains. Nucleus — urates ; the rest — fusible.

145. An oval-shaped calculus, minutely tuberculated on the surface,
and weighing 3|- drachms. It is almost homogeneous on
section, — the nucleus not well marked, and, as well as the sur-
rounding structure, composed of the urates and phosphate of
lime in varying proportions.

146. A calculus the size of a pigeon’s egg, very dark and finely
granular externally, and weighing 4 drachms.

The nucleus is soft and porous ; consists of urate of ammonia ; the sur-
rounding layers are hard and compact, and consist of uric acid.

147. A somewhat dumb-bell shaped calculus, of chalky colour and
consistency, and weighing 158 grains. Chemical composition
— entirely fusible.

148. A medium-sized calculus, of oval shape, weighing 5| drachms.

The nucleus and next concentric laminae are well defined, and consist of

urates and uric acid in about equal proportions. The rest of the
structure is homogeneous, white, and fusible.

149. A small flattened calculus, minutely tuberculated on the surface,
and weighing 138 grains.

The nucleus is dark and distinct, composed of urates, the rest is chalky
and fusible.

150. A moderately large rounded calculus, with a rough surface, and
weighing 440 grains.

The nucleus is well defined, consists of urates ; the next succeeding layer
of uric acid ; they are dark-brownish, and finely laminated.
The crust is porous, chalky, and fusible (triple phosphate and
phosphate of lime).

151. An oval-shaped calculus, of brownish colour at the surface and
towards the centre, but white and chalky intermediately. It
weighs 330 grains.

The nucleus consists of calcium oxalate, the surrounding layers and
crust of triple phosphate and phosphate of lime (fusible) .

152. A biconical fusible calculus, weighing 4^ drachms.

SERIES XX.]

VESICAL CALCULI.

665

A series of Calculi ‘presented to the Museum by Assistant- Surgeon
Raj Kissen Mookerjee, Find Dadan Khan Dispensary *

153. A large, flat, oval calculus, minutely tuberculated on the surface,
and weighing 1 ounce 80 grains ; extracted successfully from a
man, aged 35. Disease of four years’ duration.

The nucleus is large, of a yellowish-brown colour, and consists of the
urates of ammonia and lime in about equal proportions, the rest
of the stone of phosphate of lime.

154. A large, rough, oval calculus, beautifully laminated, and of
brownislnyellow colour on section. It weighs 2 ounces and
20 grains.

Successfully extracted from an old man, aged 60. Duration of disease
— 5 years.

The nucleus and next surrounding layers are well marked and distinct, —
the former consists of calcic oxalate, the latter of uric acid,
urate of ammonia, and traces of urate of lime. The crust is
composed of phosphate of lime.

155. An oval-shaped rough calculus, weighing 5 drachms.

From a boy, aged 2 years. Duration — 6 months. Result — successful.

The nucleus is distinct, and composed of uric acid ; the surrounding
structure is almost homogeneous, of yellowish-white colour, and
consists of uric acid and urate of ammonia in about equal
proportions.

156. A large, oval-shaped, yellowish-brown, rough-surfaced calculus,
weighing 2| ounces. From a native male patient, aged 35, “ still
under treatment.” Disease of four years’ duration.

The nucleus is distinct, dark coloured, and consists of uric acid.
The next surrounding layers are deficiently laminated, porous, and
composed of urate of ammonia with traces of urate of lime.
The crust is harder, and made up of uric acid.

157. Two large calculi, successfully extracted from a man, aged 20.
The disease was of eight years’ duration.

The stones have a chalky colour externally, are brownish-yellow on
section. They weigh together drachms.

The nucleus consists of uric acid ; the next surrounding layers of the
urates of ammonia and lime; the crust has a similar composition,
but with a varying admixture of oxalate of lime. “The rectum
was wounded in this case, and the man discharged with a
fistulous opening,” but otherwise cured.

158. A pyriform, rough-surfaced calculus, weighing 1 ounce 5 drachms.

Successfully removed by operation from a man, aged 40. Disease of

six years’ duration.

“ The stone was covered, when first extracted, by a thin cobweb-like
membrane ; and its surface was so very soft that it gave way
under the grasp of the forceps.”

The nucleus and next surrounding layers have a pinkish or brownish-
pink colour, and are composed of urate of ammonia. The crust is
porous, of chalky whiteness, and is fusible (triple phosphate and
phosphate of lime).

* Chemically analysed by Dr. C. J. H. Warden, Professor of Chemistry, Medical College,

666

VESICAL CALCULI.

[sEEIES XX.

159. A moderately large rounded calculus, with a finely tuberculated
surface, weighing 1 ounce 3| drachms.

From a native boy, aged 10 years. Duration of disease — 4 years.
Result — “ Still under treatment.”

The nucleus is distinct and hard ; the next layers delicately laminated.
They are composed of the urates of ammonia and lime. The
peripheral layers are porous, of a yellowish colour, and together
with the crust are made up of the phosphate of lime and uric
acid in varying proportions.

160. A very large conch-shaped calculus, of an alabaster colour, with
the exception of the nucleus, which is dark brown. The struc-
ture generally is porous. The nucleus consists of oxalate of lime with
traces of uric acid ; the rest of the stone of triple phosphate and
phosphate of lime (fusible). Large crystals of triple phosphate
are visible 'on the surface, and also throughout the porous outer
laminae of the calculus. Weight 6 ounces.

Donor unknown.

161- A large oval calculus, of chalky-white colour externally, and
markedly tuberculated at the surface. It weighs 4 ounces 7\
drachms. The nucleus is double, of light brown colour, and
beautifully laminated. It is chiefly composed of uric acid. The
peripheral thick white crust is fusible (triple phosphate and
phosphate of lime). The same material is interposed between
the two nuclei, and completely separates them from each other,
so much so, that it seems probable that originally there were two
stones, which have become fused, as it were, into one.

Donor unlcnoion.

162. A rough, oval-shaped calculus, of a pale brownish colour, and
markedly laminated on section. It weighs 4 ounces 6 drachms.

The nucleus is irregular, consists of uric acid ; the next concentric layers
of urates of ammonia and lime ; the crust of phosphate and
oxalate of lime in varying proportions.

Donor unknown.

163. A large, oval, white, coral-like calculus, weighing 1 ounce 6
drachms.

The nucleus and next surrounding ring are well marked ; the rest of the
stone is porous, not laminated. The nucleus consists of triple
phosphate, the rest of the stone of phosphate of lime and triple
phosphate (fusible), with also slight traces of uric acid.

Donor unknown.

164. An oval-shaped, chalky-looking calculus, weighing 1 ounce 2£
drachms.

The general structure is porous, — sparingly laminated towards the centre.
The nucleus is somewhat excentric, and, as well as the rest of the
stone, consists of phosphate of lime, triple phosphate, and traces
of uric acid. Large crystals of triple phosphate are diffusely
scattered throughout the porous layers of the calculus.

Donor unknoion.

165. A large pyriform calculus, weighing 3 ounces 2 drachms.

series xx.] VESICAL CALCULI. GG7

The nucleus and next surrounding layers have a yellowish-brown colour,
and are composed of uric acid. The rest of the stone is chalky,
white, and fusible.

Donor unknown.

166. A. large rounded calculus, of a chalky-white colour, and soft
externally (crust) ; hard, compact, and dark at the centre. It
weighs 3 ounces 1 drachm.

The nucleus consists of oxalate of lime ; the next concentric layers of
uric acid and calcic oxalate alternately, the thick soft crust is
fusible (triple phosphate and phosphate of lime).

Donor unknown.

167. A very large irregular-shaped calculus, curved on one side, and
obtusely pointed at one extremity, where it was impacted in the
neck of the bladder. It is very markedly tubereulated on the
surface, and throughout of a chalky-white colour. Weighs
14J ounces.

The nucleus is ill-defined ; consists of oxalate of lime ; the succeeding
layers of oxalate of lime with phosphate and carbonate of
lime in varying proportions. The peripheral structure (includ-
ing the crust) is composed of triple phosphate and phosphate
of lime. Extracted by the supra-pubic operation from a native
male, aged 53. There had been symptoms of stone in the
bladder for twelve years.

Presented by Professor W. J. Palmer.

168. A large, fiat, oval-shaped calculus, with a finely granular surface,
— weighing 2 ounces 2 drachms 8 grains.

Successfully extracted from Shaik Mogul (Mahomedan), aged 32. He
had suffered from symptoms of stone in the bladder for nine years.

The nucleus is irregular ; consists of oxalate of lime ; the rest of
the stone of alternating la}' ers of uric acid and calcium oxalate.

Presented by Dr. Vincent Richards, Civil Surgeon, Goalundo.

169. A medium-sized flat calculus, with a smooth surface, weighing
215 grains.

Extracted successfully from Kajnath (Hindu), aged 30. Duration of,
disease — 4 years.

The nucleus is not well defined consists of the urate of ammonia. The
rest of the stone is similarly composed, but contains also traces
of urate and phosphate of lime.

Presented by Dr. Vincent Richards, Civil Surgeon, Goalundo.

170. A small, oval, calculus, rough and granular at the surface, and
weighing 129 grains.

From Poresh (Bengali), aged 30, who had suffered from the disease
for 18 months. Operation successful.

The nucleus is dark ; composed of the oxalate of lime ; the next concen-
tric ring of uric acid, and the whitish crust of urate of ammonia.

Presented by Dr. Vincent Richards, Civil Surgeon, Goalundo.

171. A large oval calculus, of chalky-white colour at the surface, and
weighing 3 ounces 2 drachms.

The nucleus is porous and not wrell defined, is composed of urates.
The rest of the stone is sparingly laminated, and fusible.

Donor unknown.

668

VESICAL CALCULI.

[SEEIES XX.

172. A large, oval calculus, with a rough, pale-brownish surface, weigh-
ing 3 ounces 380 grains. Removed, by the operation of lateral
lithotomy, from a native of Bhagulpore.

The nucleus consists of uric acid ; the first surrounding layers of urate of
ammonia ; the rest of the stone, which has a generally porous
and soft structure, is composed of the urate of ammonia and
phosphate of lime in varying proportions.

Presented by Dr. Wright, Civil Surgeon, Bhagulpore.

173. A “ mulberry ” calculus weighing 300 grains.

The nucleus is composed of phosphate of lime ; the rest of the stone,
including the crust, of phosphate and oxalate of lime, with traces
of xanthine (?).

Donor unknown .

174. A small, flattened calculus, of somewhat triangular shape. It
lias a brownish, tuberculated, but polished surface, and weighs
160 grains. Removed successfully by operation from a native
male patient (adult). Duration of disease — about six months.

The nucleus is large, and composed of uric acid. The surrounding laminae
are very hard and dark, and are composed of oxalate of lime.

Presented by Professor W. J. Palmer.

175. A rounded calculus, with a thick chalky crust, a considerable
portion of which has been broken during extraction. It weighs
1 ounce 165 grains.

From a native male patient, aged 20. Operation successful.

The nucleus consists of uric acid. The next concentricj rings are deli-
cately laminated, and composed of alternating layers of uric acid
and calcium oxalate. The thick white crust is made up of phos-
phate and oxalate of lime.

Presented by Professor W. J. Palmer.

176. A flattened, very much tuberculated calculus, of irregular shape,
and weighing 280 grains.

The nucleus is large and round, composed of uric acid ; the surround-
ing structure is more or less homogeneous, consists of uric acid
with urate of ammonia, and contains traces of urate of soda and
magnesia.

Presented by Professor J. Fayrer.

A series of Calculi 'presented to the Museum by Assistant-Surgeon
Onoocool Chunder Chatter] ee, Durbhunga*

177. A large, oval calculus, with a markedly tuberculated surface (the
crust partially broken), weighing 2 ounces. From a Hindu,
aged 54.

The nucleus is ill-defined ; consists of uric acid ; the next surrounding
layers of oxalate of lime. The crust and large white nodules on
the surface are composed of phosphate of lime and triple phos-
phate (fusible).

178. A medium-sized, flattened, and rough calculus of chalky-white
colour, weighing 265 grains. From a native male (Hindu), aged
45.

* Chemically analysed by Dr. C. J. H. Warden, Professor of Chemistry, Medical College,
Calcutta.

SEEIES XX.]

VESICAL CALCULI.

6C9

The nucleus is dark, excentric, and composed of oxalate of ammonia.
The surrounding structure is soft and porous, consists of the urate
of ammonia and triple phosphate in various proportions.

179. A oval-shaped calculus, rather larger than a sparrow’s egg, with
a finely granular surface, and weighing 70 grains. From a native
(Hindu) boy, six years of age.

The nucleus is dark, composed cf calcic oxalate. The surrounding layers
and crust are porous and not laminated, and are made up of
triple phosphate and urate of ammonia, with traces of phosphate
of lime.

180. An entire flattened calculus, with a rough tubereulated surface
weighing 100 grains. From a Hindu, aged GO.

The nucleus is composed of urate of ammonia ; the surrounding layers
of oxalate and phosphate of lime in varying proportions.

181. Two small, rounded, smooth-surfaced calculi, each weighing 75
grains. From a Hindu boy, aged 4 years.

They seem to have the same chemical composition : — the nucleus consists
ol urate of ammonia, the next concentric laminae of oxalate of
lime, and the crust of triple phosphate, with traces of phosphate
of lime. 1

182. T wo small calculi,— one the size of a bean, the other of a pea.
They have rough, granulated surfaces, and weigh, respectively, 20
and 3 grains. From a native male (Hindu), aged 3G. The’ cal-
culi are composed of urate of ammonia and oxalate of lime in
about equal proportions.

A senes of Calculi removed by lateral lithotomy , by the late Surgeon -
Major Baillie Civil Surgeon, Bhagulpore.— Chemically anal used
and presented to the Museum by Professor C. J. H. Warden.

183. A conical-shaped calculus, with a chalky surface, and weighing

110 grains. s °

From a native child aged 10 years. Result-cured,
lhe nucleus consists of oxalate of lime; the next surrounding layers of
urates ; the crust of calcium phosphate.

184. An elongated, dumbbell-shaped calculus, weighing 280 grains
Irons a Hindu, aged 24 ;- Symptoms of stun? had existed for
10 years. Result— cured.

The nucleus is pale-brown in colour, and composed of urates: the rest
iQi> c* the structure is fusible (triple phosphate and phosphate of lime).
Io5. An oval calculus with a pale-brownish crust, partial] v broken
It weighs 536 grains. Successfully extracted from a native male*
agecl 2o, Duration of symptoms — one year,
the nucleus consists of urates ; the next dark lamina of oxalate of lime
this is succeeded by alternating rings of. dark and white colour’
composed respectively, of calcium oxalate and phosphate The
peripheral layers are fusible (triple phosphate and phosphate of
ion a , ’ but thu final encrusting substance consists of urates,
lob. A large, oval-shaped, rough calculus, weighing 1,265 grains

1 rom a native male, aged 25. Duration of symptoms — 12°vears
Result — successful. 1 jtais.

670

YESICAL CALCULI.

[series XX.

The nucleus is indistinct, the general structure porous and loosely
laminated. The former is composed of urates ; the rest of
the stone of alternating layers of uric acid and urate of
ammonia.

187. A medium- sized oval calculus, with a chalky-white crust, and
weighing 390 grains. Successfully extracted from a native boy,
aged 7 years. Duration of symptoms— 2 years.

The nucleus consists of urates ; the surrounding layers of urates and
uric acid ; the crust of triple phosphate and phosphate of lime
(fusible).

188. A oval-shaped tuberculated calculus, weighing 320 grains. From
a native child, aged 7 years. Duration of symptoms — one year.
Result — successful.

The nucleus is composed of urates ; the rest of the stone, except the
thin whitish crust, has a dark slate-colour, and is very firm
and compact. It consists of oxalate of lime. The crust is
formed by a deposit of phosphate of lime.

189. A small oval calculus, weighing 155 grains. Successfully removed
from a native child, aged 11 years. Symptoms of stone had
existed for six months.

The nucleus is distinct, and composed of urates. The surrounding
dark, smooth, non-laminated structure consists of calcic oxalate ;
the crust of urates.

190. A rough, tuberculated, oval calculus, weighing 502 grains. From
a native male, aged 18. Duration of symptoms — 6 years.
Operation successful.

The nucleus is well defined and composed of urates ; the next layers
of urates and uric acid in varying proportions. The crust is
formed by phosphate of lime.

191. A dark-brownish, remarkably tuberculated calculus, weighing 210
grains. Successfully extracted from a native boy, aged 8
years. Duration of symptoms — nine months.

The nucleus is oval-shaped and distinct ; consists of urates. The
surrounding laminae are composed of uric acid and urates in
alternation. The crust is fusible.

192. An oval-shaped, rough-surfaced calculus, weighing 503 grains.
Tbe patient was “ an old man,” who died six days after the
operation from haemorrhage. Symptoms of stone had existed
for twelve months.

The nucleus is large and distinct, composed of urates, the succeeding
structure of concentric alternating rings of uric acid and
urates.

193. An irregular-shaped calculus, removed in two pieces from the

bladder of a native boy, aged 10 years. The constricted narrow
portion was firmly lodged in the neck of the bladder, and broke
off from the rest of the stone on the application of the forceps.
The patient made a good recovery. \

The calculus is of chalky colour externally, pale-brown and laminated
on section. The nucleus consists of urates, the remaining
structure of alternating rings of triple phosphate and phosphate
of lime, and urates. Weight— 2G0 grains.

SERIES XX.]

VESICAL CALCULI.

671

194. A large, oval calculus, with a soft white crust, but very hard and
compact body. It weighs 670 grains

Successfully extracted from “an old man,” who had suffered from symp.
toms ot stone for three years. 1

fhe nucleus consists of uric acid ; the succeeding laminae of oxalate
fusible6 aiKl UnC aCld 1U ProP°rtions ; the crust is

195. A very curiously-shaped calculus, weighing 410 grains, removed
successfully from “a young man.” The lower bi-conical portion
was lodged in the neck of the bladder, and broke off, during
extraction from the flattened part of the stone. The former

ti aind Sm°0th on its uPPer asPeet, rough elsewhere.

I he flattened caput is everywhere rough and minutelv tuber,
culated. The structure of both portions consists of urates with
uric acid, in alternating deposit.

196. A rough, oval-shaped, fawn-coloured calculus, which weighed

on extraction 195 grains. From a native boy, aged G years.
Operation successful. ° J

The nucleus is composed of urates, the next layers of uric acid, the crust

_ A tni, e PhosPhate and phosphate of lime (fusible).

197. A calculus, the “ size, colour, and shape of a large duck’s ego- ”

and weighing 1,265 grains. ba>

Successfully extracted from a native male patient, aged 25, who had
suffered from symptoms of stone for fifteen years. The nucleus is
excentnc, and apparently composed of a small blood-elot ; the
succeeding structure is laminated, and consists of urates ; the thick,

“ f0™ed by «Ple ph-pht* -a

198.

phosphate of lime (fusible).
Two irregular-shaped face,

Kin i T r facetted calculi, successfully removed from

the bladder of an “adult” native. One calculus has a single
Jacet the other two. These are smooth, white, and polished.
I lie two stones lay closely opposed to each other by the
la ger polished surfaces, one of which is slightly concave, the
other correspondmgiy convex. From the upper and anterior
le °J °n® ca]culusa rough process, nearly half an inch in

-.th, piojects. This was impacted in the urethra. No third

calcuk,s was found. The two removed weighed together 035

w 1 i'll II O .

i fla,ttened ca,eulus, with a thick brownish-white crust,
partially broken in removal. It weighs 1,295 grains

Successful y extracted from a native male "patient, afed 30, who is said
to have suffered from symptoms of stone for ten years,
nucleus is oval-shaped, and, with the surrounding lamina, which
urates6 comPosed of uric acid. The crust consists of

200.

199.

The

An elongated, oval-shaped calculus, weighing l ounce 2k

tZ,"Xr , '""l n VtTy old man’” who liacl offered from symp.
toms of stone fo, fl ve years, and who died from exhaustion, &L
on the seventeenth day after the operation.

nUnextSlfliSPPa11 andi Tgular’ comP°sed of palate of lime. The
next la^tr has a pale-brownish colour, and consists of urate.- :

672

VESICAL CALCULI.

[SEEIES XX.

calcic oxalate and urates make up the succeeding laminae,
which are well defined. The crust is porous, white, and fusible.

201. A smooth-surfaced, oval calculus, of a pale-yellowish colour on
section, and weighing 27 L grains.

Successfully extracted from a native boy, four years of age. Duration
of symptoms — three years.

The nucleus is composed of urates, the surrounding concentric rings
and crust of uric acid and urates in varying proportions.

202. A very characteristic “mulberry” calculus, having a remarkably
tuberculated surface, and weighing 155 grains. No history.

The nucleus is composed of urates, the next and largest layer of oxalate
of lime, which is succeeded by a thin crust of urates.

A series of Calculi presented to the Museum by Dr George A. Watson,
removed by operation at the Civil Stations of Shahgore and
Goojrat. (Deceived in 1SG7.)#

203. A large, oval-shaped, but flattened, calculus, yellowish-brown on
the surface and also on section. It weighs 3 ounces 4 drachms
and 38 grains.

The nucleus consists of urates, the remaining structure of uric acid and
urates in alternating laminae.

204. An enormous, irregular-shaped calculus, with a rough chalky
surface, and weighing 9 ounces 1 drachm. It is firm and
compact on section, exhibits no lamination, and no distinct
nucleus.

The structure consists of triple phosphate and phosphate of lime (fusible).
No history.

205. A large, oval, rough-surfaced calculus, weighing 2 oui ces
6i drachms.

The nucleus and next concentric layers have a pale-brownish colour,
and are composed of urates. The crust is thick, white, homo-
geneous and fusible.

206. A' pyriform calculus, weighing 2 ounces 20 grains. The
external surface is minutely granular and tuberculated, the
structure, as seen on section, is porous, and almost destitute of
lamination. The nucleus is small but distinct, consists of uric
acid, the rest of the calculus of urates.

207. A somewhat spindle-shaped large calculus, of a reddish-yellow
colour and rough surface, weighing 2 ounces G| drachms.

The nucleus is distinct, of a slate colour, composed of calcic oxalate.
The next layer is porous, and composed of urates. The peripheral
structure is compact, laminated, and consists almost entirely of
uric acid,

208. A flattened, oval calculus, of brownish-yellow colour, weighing
1 ounce G drachms 8 grains.

The nucleus is large, ill-defined, and porous ; consists of urates. The
remaining structure is firm, compact, delicately laminated, and
composed of uric acid.

209. An oval, rough-surfaced calculus, weighing 1 ounce 4% drachms.
The nucleus is brownish in colour, and composed of urates; the

* Chemically analysed by Professor C. J. H. Warden.

8EEIES XX.]

VESICAL CALCULI.

073

next layers are very dark and porous, formed by calcium oxalate.
The crust is white, composed of triple phosphate, — large crystals
of which are scattered profusely over the surface of the stone.

210. An oval-shaped large calculus, of yellowish-brown colour, and very
delicately laminated on section. It weighs 1 ounce 7 drachms
20 grains.

The nucleus consists of urates, the surrounding concentric rings of
uric acid and urates in varying proportions.

211. A medium-sized, oval calculus, with a thick, rough, and chalky-
white crust. It weighs 1 ounce 1 drachm 10 grains.

The nucleus and succeeding layers have a slate colour, and are composed
of uric acid ; the porous white crust of triple phosphate and
phosphate of lime (fusible).

212. A large reniform calculus, having a dark brown surface, and
weighing 1 ounce drachms.

The nucleus is irregular but distinct, composed of uric acid. The next
layers are porous and consist of urates. The crust is compact,
hard, and laminated, is composed of uric acid.

213. A large oval calculus, finely granulated at the surface, and of a
dark-brown colour. It weighs 1 ounce G drachms 10 grains.

The nucleus is porous, composed of urates ; the remaining structure,
including the crust, is compact and delicately laminated, — con-
sists chiefly of uric acid.

214. A large, somewhat pyriform calculus, with a partly smooth
and partly rough surface, weighing 1 ounce 5 drachms 20 grains.

The nucleus is irregular in shape, of a dark slate colour, and composed
of oxalate of lime. The next layers are porous, and consist of
urate of ammonia. The crust is chiefly formed of triple phos-
phate and phosphate of lime (fusible).

215. A large, remarkably tuberculated calculus, with a yellowish
surface, and weighing 1 ounce IS grains.

The nucleus is ill-defined, composed of urates ; this is succeeded by
oxalate of lime, which constitutes the principal or main structure,
and in turn receives a thin deposit or crust of urates.

216. A flattened oval calculus, of brownish-yellow colour, wcmhino-
1 ounce 18 grains.

The nucleus is not well marked. The central portions of the stone are
poious, the peripheral laminated and compact. The former are
chiefly composed of urates, the latter of uric acid.

217. A medium-sized, remarkably tuberculated calculus, having a thin
and imperfect whitish crust, and weighing 1 ounce 1 drachm.

The nucleus is well defined, and consists of urates, the surrounding
laminae (and greater part of the stone) of oxalate of lime ; the
crust of triple phosphate and phosphate of lime (fusible).

218. A typical “ mulberry” calculus, showing a very characteristically
tuberculated surface, and compact structure. It consists of
almost pure oxalate of lime, and weighs G drahms 15 grains.

219. A medium-sized oval calculus, having a chalky surface and
weighing 6£ drachms. The nucleus is well marked, and consists
of uric acid. The succeeding layers are porous, but become
compact and homogeneous towards the periphery. They are

VESICAL CALCULI.

674

[SEUIES XX.

chiefly composed of triple phosphate and phosphate of lime
(fusible).

220. An oval-shaped, rough-surfaced calculus, of a brownish-yellow
colour, and weighing 5 drachms 44 grains.

The nucleus is not well marked, consists of oxalate of lime, the remain-
ing structure (including the crust) of urates, with only a small
admixture of calcic oxalate.

221. A rounded, rough-surfaced calculus, weighing 4 drachms 45
grains.

The nucleus is not well defined, and of dark colour, — is composed of
oxalate of lime ; the surrounding compact structure consists of
triple phosphate, with traces of urates.

222. A small oval calculus, of yellowish colour, and markedly lami-
nated on section. It weighs 4 drachms 12 grains.

The nucleus is not well marked, consists of urates, the rest of the stone
is composed of uric acid and urates in alternating concentric
layers.

223. A cone-shaped calculus, — probably from the neck of the bladder, —
weighing 5 drachms.

The nucleus is ill-defined, composed of urates ; the next succeeding layers
of phosphate of lime with traces of urates ; the thick white
and soft crust is formed entirely by calcium phosphate.

224. Two calculi, — one very large, flattened, and partially polished;
the other, concavo-convex, and with a smooth marble-like surface.
They weigh together 9 ounces.

Eemoved by the bilateral operation from a native male (Hindu) patient,
who had suffered from the disease “ for nearly 20 years.” He
died from peritonitis on the eight day after the operation.

The larger calculus has a well defined nucleus composed of urates; this
is succeeded by a thin layer of triple phosphate ; a broad deposit
of urates is next observed, and, finally, the very large thick crust
is made up of triple phosphate and phosphate of lime (fusible).
The smaller calculus has the same chemical composition.

Presented by Assistant-Surgeon Jadub Krishto Sen, in charge of the
Sudder Dispensary, Fyzabad.

225. An-oval shaped, apparently lithic acid calculus, with a slight
phosphatic coating, and weighing 390 grains.

“ Extracted from the bladder of a little girl, aged six years.”

Presented by Mr. J. Wadrateck, Civil Surgeon, Dobeira, Jeypore

226 231. A series of vesical calculi.

Presented by Assistant-Surgeon C. E. Haddock.

232-238. A scries of vesical calculi.

Presented by Assistant-Surgeon Shama Churn Dey.

239 240. T wo large, oval, rough -surfaced vesical calculi.

Presented by Assistant-Surgeon Eamsoonder Ghose.

241. A very large, irregularly rounded and tuberculated calculus.
Presented by Assistant-Surgeon Nilmadub Mookerjee.

242-250. Vesical calculi of varying size and chemical composition.
No history.

Donors unknown.

6EEIE9 xx.] URETHRAL AND PROSTATIC CALCULI.

Urethral Calculi.

9^1 An elongated, chiefly urethral, calculus, with a. flattened knob or
head at °one extremity, which was lodged in the neck of the
bladder. The stem of the calculus occupied the prostatic portion
of the urethra, which was much dilated. Weight —195 grains.

Successfully extracted from a native male patient.

Presented hy Professor S. B. Partridge.

252-253 Two urethral calculi — one elongated, three-foui ths ol an inch
in length, and rough ; the other, rather larger than a pea, and
smooth. The former weighs 12 grains, the latter 2\ grains.
Extracted successfully, — the larger from a native lad, aged 1G ;
the smaller from a child, two years of age.

Presented hu Dr. Birch, Civil Surgeon, Hazaribagh.

254 A “ mulberry-like” rounded calculus, nearly as large as a betelnut,
’ removed from the urethra. It had probably. formed in the
prostrate, and, travelling downwards, become impacted in the
fossa navicularis • It now caused retention ot uime, with gieat
oedema of the glans and prepuce, and “ was removed (under
chloroform) by slitting up the meatus sufficiently to allow of its

removed from a native

polished surface, and
slight incision of the

passage.” . . . , , „

The nucleus consists of urate of ammonia, the remaining structure ot
phosphate and carbonate of lime. Weight — GO grains. Prom a
native male “ out-patient.”

Presented by Dr. E Lawrie.

255. A urethral calculus, weighing 3 grains,
male patient, aged 47.

Presented by Professor S. B. Partidge.

256. Urethral calculus, having a dark-brown
weighing 28 1 grains. “ Extracted, with
orifice, from the spongy portion of the urethra of Goolam Hos-
sein Mia, a Mahomedan khalassi, aged 25.”

Presented by Professor S. B. Partridge.

256a. a small calculus, very much resembling in shape and size a
* date-stone. The surface is rough, undone side deeply grooved.
It weighs 14 grains. “ Extracted from the urethra of a native
female, aged 34.”

No trace of any vegetable substance entering into the composition of the
calculus can be detected. The nucleus consists of lithic acid,
the crust of mixed phosphates.

Presented by Baboo Kailas Chunder Mookerjee, m.b., Chinsurah.

257. “ A prostatic calculus,” weighing 8 grains, removed from the
prostate of “ an old man,” during the operation of lateral lithotomy
(for vesical calculus).

Presented by Dr. Lyons, Rawul Pindi.

258. The' prostate gland of an elderly European, who died from
dysentery, showing numerous corpora amylacea, — some of large
size, of a dark-blue or black colour, hard and gritty. The
smaller concretions display, under the microscope, a distinctly
concentric or laminated structure.

259. A renal calculus, weighing 4 grains, passed per uretliram by
a European (military officer). The patient was suddenly seized

076

RENAL CALCULI.

[series XX.

with very severe pain in the left lumbar region. “ The possi-
bility of a renal calculus was suspected at the time. A good
dose of laudanum with fomentations gave relief in a^few
hours. About five weeks after the attack this small roughened
calculus was passed by the urethra.”

Presented by Surgeon-Major E. T. Lyons, Roorkee.

260. F ive calculi, removed post-mortem, from the kidneys of a native
male prisoner, who died in the Banda jail. Four of these
calculi are very irregular (dendritic) in shape ; of these, three
were lodged in the right kidney, and one in the loft. The fifth
is smooth and rounded, polished over one-half, and lay in a
cup-like cavity hollowed out of the largest calculus in the
right kidney. Together the calculi weigh a little over G|
ounces, and are composed of triple phosphate and phosphate
of lime (fusible).

Presented by Dr. Ringer, Surgeon, 4-0th Regiment Native Infantry,
Banda.

261. “A bit of slate-pencil, about two inches long, removed by-
lithotomy from the bladder of an adult Hindu. It is covered
with phosphatic deposit, except at the ends, which are rounded
off from use, showing that it is not a portion of a longer pencil,
broken in the urethra, but must have been of its present size
when introduced.”

“ The patient professed ignorance of how it entered the bladder.” —
(Colles),

Presented bp Dr. Herbert Baillie.

262. A rounded piece of wood, nearly two inches in length, and
a third of an inch in thickness, removed from the bladder of a
young Rajput woman. It formed the nucleus of a soft cal-
culous mass, consisting of phosphates, as may be seen in the
preparation.

Presented by Surgeon-Major DeFabeck.

263. “ The gall-bladder of a dysenteric patient, containing numerous
calculi, some of which are still in situ , others have fallen out.”
(Colles).

They are about the size of ordinary peas, facetted, and chiefly com-
posed of pure white cholesterine.

Presented by Professor Chuckerbutty.

264. A pure cholesterine-calculus, from the gall-bladder of an East
Indian female, aged 80, who died of chronic diarrhoea.

It it rather larger than a nutmeg, oval in shape, slightly tuberculated
at the surface, and of a brillient pearly-white structure
throughout. Microscopical examination displays large super-
imposed plates of pure cholesterine.

265. An oval cholesterine calculus, about the size of a hazelnut,
obtained from the gall-bladder of a native female, aged 50,
who died of chronic dysentery. The gall-bladder was greatly
contracted, and, besides this calculus, contained only a few drops
of milky, opaque-white secretion. The cystic duct was almost
obliterated, the hepatic and choledic ducts were widely dilated.

SERIES XX.]

BILIARY CALCULI.

677

266 About a dozen gall-stones, varying in size from that of a
hazelnut to that of a pea, removed from the gall-bladder ot a
native male (Hindu), aged 36, who died of hepatic abscess.
The calculi, on section, present a central biliary (dark) nucleus,
surrounded by brilliant, yellowish-white, concentric laminae of

cholesterine. . . , ,

267. A biliary calculus, the size of a betelnut. It has a central dark
pigmentary nucleus, surrounded by a thick pearly-white crust of
almost pure cholesterine. Found, with fragments of a second
similar concretion, in the gall-bladder of a native female, who
died of exhaustion after delivery.

268. Seven gall-stones, varying in size from a pigeon’s egg to a pea.
They are facetted, and the majority have dark polished surfaces.
Their structure consists of an admixture of biliary colouring
matter and cholesterine, the former preponderating. No history.

Presented by Dr. J. Balfour.

269. Half-a-dozen biliary calculi, each about the size of a hazelnut,
and irregularly rounded, found in the gall-bladder of a native
(Mahomedan) male patient, who died from remittent fever.

They are seen, on section, to be composed chiefly of dark biliary pig-
ment, but with an admixture of yellowish-white shiny particles
of cholesterine.

270. Three facetted gall-stones, found at the bottom of a sinus, four
inches in length, leading from the abdominal wall towards the
liver. They are seen to consist principally of biliary colouring
matter disposed in concentric laminae. From a Hindu, aged 45.

The patient was admitted with a circumscribed rounded swelling in the right
hypochondriac region, which discharged thick hepatic-looking pus, in
small quantities, from two fistulous openings on its surface.

About two years previously, the man had been an in-patient at this hospital
(Medical College), and was operated upon for what was then believed to be
a parietal (abdominal) abscess. He left before the wound healed, and states
that it gradually contracted, but has never ceased to discharge, i.e., for two
years.

On re-admission, the fistulre were enlarged, and the intervening bridle, of very
dense cicatricial- like tissue, freely incised. Two days after, in dressing
the wound, something hard and “ metallic” was felt with a probe at its
deepest part, and by means of a scoop, a facetted gall-stone, the size of a
hazelnut, was extracted ; two others, of about the same size, were then
easily removed. The patient made an excellent recovery, the wound
healing readily and completely before he left the hospital. The “ parietal ”
abscess, for which he was operated upon on first admission, evidently did
communicate with the liver (i.e., gall-bladder).

271.

About a dozen biliary calculi, found impacted in the gall-bladder
of a native woman, aged 35, who died from acute peritonitis

following abortion.

Each gall-stone is about the size of a

small

hazelnut, is facetted, and consists of a central large nucleus of
dark colouring matter, with a crust of cholesterine.

272. “ Four gall-stones, filling the gall-bladder, which was much con-

tracted” (Colles). No history. One calculus is the size of a
sparrow’s egg, and its surface tuberculated. The others
pea-like, smooth, and facetted.

Presented by Professor Chuckerbutty.

678 INTESTINAL CONCRETIONS. [semes xx.

273. “ Several gall-stones, removed from an encysted cavity in the
abdominal parieties. They were contained in a pouch, in size
and shape resembling the gall-bladder.”

“ The patient, Mr. C. B. N- , aged 47, of mixed parentage, did

well.” (Ewart).

Presented by Dr. Herbert Baillie.

274. Half of an intestinal calculus or concretion, extracted from the
rectum of a native male, — “ adult.” When entire, the calculus was
the size of a small hen’s egg. The surface has a dark olive
colour. On section, the nucleus is reddish-brown and felt-like ;
it consists of vegetable fibre in a fine state of subdivision and
pigment matter — fceculent or biliary. The surrounding structure
is very hard and compact, chiefly composed of oxalate of lime,
with a varying admixture of cystine. “ No uric acid or phos-
phates can be detected.”

“ The patient came to the Midnapore charitable dispensary complaining of pain
along the transverse colon, and obstruction of the bowels. He was treated
with large enemata of turpentine and castor-oil, and a strong purgative.
Next day he returned, having been copiously purged, but still complaining
of great uneasiness and pain at the anus, accompanied by a feeling of
weight. A digital examination was made, the calculus detected, and
removed by the forefinger and a scoop. The man obtained immediate
relief, and was discharged cured. No history could be obtained to throw
light on the origin of the mass.”

Presented by Dr. R. G. Matthew, Civil Surgeon, Midnapore.

275. An intestinal concretion, removed by the finger, from the rectum
of Chooni Lai, a native boy, aged 10 years, admitted into hospital
for obstruction of the bowels, of ten days’ duration. The
abdomen was greatly distended and painful. Warm emollient
enemata brought away small dry bits of foecal matter the first
day ; on the second, fragments of a curious looking, reddish,
clay-like material were noticed in the evacuations. An intestinal
concretion was suspected, and, on a digital examination of the
rectum, a hard solid mass was detected, firmly lodged in the
bowel, and occupying the hollow of the sacrum. By a little
manipulation it was removed entire, and is seen to be about the
size of a small orange. It was coated externally with soft
yellow fccculent matter, which, on being washed away, revealed a
hard greenish crust of pigment matter, the interior of which
was occupied by soft, friable, reddish, clay-like material.

On microscopic examination, this is found to consist almost exclusively of vegetable
matter, — the husks of some graminaceous plant. The longitudinal large
cells ot the testa are distinct, as also the more oval-shaped or hexagonal
cells of the deeper cont, filled with reddish-brown colouring matter.

The removal of the concretion was followed by the complete relief of
all the symptoms of obstruction, and the boy left the hospital
quite cured.

No history of any morbid appetite for indigestible matter could be
elicited from the patient or his friends.

276- An intestinal concretion, about the size of a walnut, rounded
in outline, but a little flattened on one side, — where it seems to

SERI E8 XX.]

LACHRYMAL CONCRETIONS.

079

have adhered or been attached to the mucous membrane of the
bowel. The surface is rough, and of a greenish-yellow colour.
It weighs about 0^ drachms. On a section being made, the
nucleus is seen to be composed of a betelnut (the pigmented
vegetable structure of which is confirmed by microscopic
examination) ; the crust is calcareous, very dense and hard, and
composed principally of oxalate of lime.

The patient was a native woman, aged 36, a resident of Comillah. She is said to
have suffered from “ gastric pain” for fourteen years, and latterly, from
much epigast ric tenderness, and incessant vomiting. She was in the habit
of eating baked-clay bisnuits — “ a practice common amongst native women
in these parts, during pregnancy.” After being treated for over a week
by opium administered internally, blistering and cupping cf the abdomen,
and emollient enemata, she passed this concretion, and obtained immediate
relief from all her distressing symptoms.

Presented hj Dr. J. A. Greene, Civil Surgeon, Tipperah,

277. A black metallic pin, a little over an inch in length, found,
post mortem , imbedded in the substance of the right lobe of the
liver, close to the surface, and at about the centre of its upper or
anterior aspect.

From an American seaman, aged 33, who died in hospital of acute
suppurative nephritis, following chronic inflammation of the
urinary bladder.

278. A very remarkable petrifaction or concretion, consisting of a
portion of lal chittra {plumbago rosea), about six inches in
length, covered by a laminated deposit of carbonate and phosphate
of lime. It was found encysted in the left iliac fossa of the
body of a native female, brought to the dissecting-room ; and
had, apparently, lain in this situation for a long period. There
was much matting together of the pelvic viscera, due to old
inflammatory changes, but no evidence of any recent mischief.
It is not known what caused the death of the woman.

The stick or stem of lal chittra had probably been used for the purpose
of procuring abortion, and had been thrust through the posterior
cul-de-sac or left lateral wall of the vagina, and had thus gradu-
ally made its way into the peritoneal cavity.

Presented by ProfessorS. B. Partridge.

279. A Meibomian concretion, removed from a dilated and occluded
follicle on the under surface of the left superior eyelid of a
native male patient. A cystic development had taken place, and,
amidst the usual sebaceous contents of the same, this small
concretion was found. It is distinctly calcareous, about the
size of a split-pea, yellowish-white and rough.

Presented by Professor H. Cayley.

280. A lachrymal concretion, found at the inner canthus of the eye,
imbedded in a small cystic growth, —probably the hypertrophied
caruncula lachrymalis. The latter was ligatured and excised,
and, on opening it, this small concretion was discovered firmly
attached to the interior, by its narrowest portion or root. It is
of pearly- white colour, and as hard as enamel, — has something of

680

FIBRINOUS CASTS AND CONCRETIONS, [sebies xx.

the shape of a deciduous incisor tooth. From a native male
(adult) out-patient.

Presented by Mr. J. R. Wallace, l.b.c.s.e.

281. A diphtheritic tubular cast of the lower half of the trachea,
and of the right and left bronchus, from a native boy, aged 10
years.

The patient was admitted into hospital, on the 18th July 1878, with
a history of fever and sore-throat, of five days’ duration. The
soft palate and tonsils were covered by a thick, white, leathery
membrane. Tracheotomy was performed the same afternoon,
as the breathing became greatly embarrassed, and all other
symptoms aggravated. On the morning of the 20th, acute
dyspnoea suddenly supervened, apparently from obstruction of
the tracheotomy-tube. On its removal, this cast was expelled
from the wound during a violent paroxysm of coughing, and
the boy was at once relieved.

The cast is about four inches in length, and, except for one or two .
small rents in its walls, forms a complete hollow mould of the
trachea and bronchi. It has a dull white colour, is smooth
externally, internally somewhat flocculent ; — closely resembles a
decolourized fibrinous clot of the heart.

Under the microscope, the structure consists of closely packed very numerous
leucocytes, having one, two, or three sharply defined nuclei ; red blood-
corpuscles ; blood colouring-matter ; a great many free nuclei (bioplasts) ;
and a few epithelial, degenerated or altered cells. All these are held
together by a finely filamentous, granular basis-substance,— evidently fibrin
or fibrinous in character. The cast, therefore, consists of solidified crupous
exudation-material, — is cellulo-fibrinous not epithelial.

282. A similar preparation. A diphtheritic cast of the lower two
inches of the trachea, of the right and left bronchus, and of the
primary branches of the right bronchus. It was coughed up
“ through a tracheotomy-tube, two days after the operation. The
child lived for nine days more, and died finally of asthenia
( ? paralysis of the heart).”

The general and microscopic characters arc the same as those of the
preceding preparation.

Presented by Dr. George Chambers.

283. Bronchial casts (fibrinous polypi or concretions). They are four
in number ; each from an inch to an inch and a half in length,
and from one-fourth to one-third of an inch in diameter.
Coughed up by a European male patient, suffering from so-called
plastic bronchitis. They exhibit a highly plicated or stratified
structure, — delicate, peliucid, more or less homogeneous, flaky,
membranous layers overlying each other, and capable of separ-
ation with needles. The concretions are solid, and, under the
microscope, a finely granular fibrinous basis-substance is seen, in
which are imbedded numbers of large and small, round or oval,
highly granular epithelial cells, leucocytes, and a few red blood-
corpuscles.

284. A calcareous concretion expectorated during a violent fit ot
coughing — accompanied by slight haemoptysis — by a European^

681

series xx.] FOREIGN BODY IN THE PLEURA.

Charles Y. , aged 49, suffering from chronic bronchitis. It

is rather larger than a pea, hollowed so as to form a shell ; the
external surface rough, marked by little pits and (apparent y)
vascular grooves ; and composed chiefly, if not entirely, or car-
bonate of lime (effervescence taking place when _ a minute
particle is treated with dilute hydrochloric acid). It is evidently
a portion of a dried up caseous mass, either in the lung
substance, or within a dilated bronchial tube.

285. A piece of thin pointed bamboo, about four inches in length,
found in the right pleural cavity of a native male (Hindu), aged
20, who died of (traumatic) empyema. The whole of the lung
was almost completely carnified. The piece of bamboo lay
close to it, but not encysted,— merely covered by a thin soft
blood-clot of recent origin.

The patient, about a year previously, fell from a date-palm, and alighted
upon some bamboo-work (fencing), but had no idea that a
fragment from the latter had penetrated the chest- wall. He was
admitted into hospital with a fistulous opening between the
second and third ribs, two inches to the inner side of the axillary
border of the right scapula, through which purulent discharge
escaped continuously, in small quantities. A counter-opening
was made between the fifth and sixth ribs, in the axilluiy
line, and the pleural cavity freely drained. The man, however,
died from exhaustion, and the piece of bamboo was only
discovered on post mortem examination.

286. A preparation exhibiting a section from the skin, subcutaneous
cellular tissue, and superficial muscles of the inner side of the
right forearm. Deeply imbedded in the muscular substance is
a splinter of wood, two inches in length, which had evidently
gained entrance through a wound in the skin, — seen to have quite
healed, — and is represented by a linear cicatrix (indicated bv a
bristle in the preparation). The patient, a native male, aged 19,
died from traumatic tetanus, on the 11th day of the injury and
third day of the disease. He gave a history of having received
a blew with a lathi on the forearm, but the presence of the
splinter was unsuspected during life, and only discovered post
mortem.

287. A preparation showing a thick-walled fibrous cyst, about the
size of a small orange, — removed from the back of the right elbow-
joint of a native (Jubbha Thakoor), aged 35. It was occupied
by coagulated and altered blood, and, at one part, by a
bullet, which can readily be recognized. The cyst-wall is
composed of dense white fibrous tissue ; is somewhat hour-glass-
shaped ; and, in the upper and smaller expansion, is the flattened
and misshapen bullet, surrounded by decolourised and partially
organized blood-clot. The lower portion contained the same
material (blood coagulum), imbedded in which two small pieces of
lead were found, — evidently detached fragments of the same bullet.
The man stated that, 18 years ago, he had been struck by a
bullet at the lower part of the back of the right arm, and
he showed a well marked cicatrix, about two inches above the cyst

032

ENCYSTED AND IMPACTED BULLETS. [semes xx

where the missile had entered. It had thus lodged in the
subcutaneous tissues at the back of the elbow for this long period,
and the cyst, now described, had formed around it. Recently’
from some cause unknown, a small abscess had appeared by the
side of the cyst ; it was opened, and, on probing the part, a
hard irregular body was discovered — the impacted bullet. He
was thereupon persuaded to have the entire cyst excised.

Presented by Dr. C. D. McReddie, Civil Surgeon, Hurdui (Oudh).

288. A preparation showing the impaction of two conical bullets at
the base of the skull, a little to the inner side of the middle
lacerated foramen. One bullet has penetrated the skull, and
its conical end is seen roughened. The other has followed in
the same track, and become flattened against the base of the
first.

From John Norman, a European seaman, aged 35, who attempted
suicide, by shooting himself through the mouth, with a small
pocket-revolver, while being carried in a palki.

The man was admitted into the hospital, quite unconscious, on the 30th July 1878.

His face and lips were impregnated with gunpowder, as also the inside of
the mouth. There was a small furrow or depression in the hard palate,
ending in a minute aperture in the soft palate, through which even a
probe could not be passed. There was great difficulty in swallowing. The
next day he partially regained consciousness, and could swallow better,
but the right side of the body, i.e ., right arm and leg, were found
to be paralysed (entire loss of motion, and of sensation to slight
extent). On the 7th day he became quite conscious, and had very little
difficulty in swallowing, but his speech was indistinct — there was loss
of articulating power. From the 8th to the 13th day he improved
considerably, recovering partially the use of the limbs, and speaking
more distinctly. On the 14*th day he complained of pain in the
head. The left eyeball was noticed to be slightly prominent, and there was
marked diplopia; speech became again thick and embarrassed; and loss
of power in the right arm and leg were more pronounced. These symp-
toms gradually increased, the intellect becoming dull, and the paralysis
more complete. Two days before his death the paralysis extended to the
opposite (left) side of the body. The patient became, slowly, quite
insensible, the breathing stertorous, and he died comatose on the 22nd
August, 1878, -on the 23 rd day. The temperature varied from 101°F.
to 102°4F., — rising to 105°F. the day preceding death.

Presented by the Police Surgeon.

289. “ A bezoar taken from the stomach of a giraffe in March 1840.
The surface is smooth and slightly oval.” It is hollow and
felt-like in the interior.

290. A mass of hair, “ taken from the stomach of an alligator. The
hair of which it is composed is black and thick, like that of
the Hindu race.” (Ewart).

291- “ A bezoar from the stomach of an alligator.” The mass is

fifteen inches in circumference, and chiefly composed of coarse
dark hair.

Presented by Mr. Simon Nicholson. #

292* A similar hairy concretion, “ from the stomach of an alligator.

293. The bones of the right arm and forearm (human), together with
a steel bracelet and other ornaments, “ found in the stomach of
an alligator.”

APPENDIX A.

CASTS, WAX MODELS, AND PATHOLOGICAL

DRAWINGS.

INDEX.

I.— CASTS—

1. — Affections of the bones and joints, 1, 2, 3, 4.

2. — Affections of the blood-vessels (aneurisms), 5, 6, 7.

3. — Diseases of the skin, 8, 9, 10.

4. — Tumours and mokbid growths, 11, 12, 13.

5. — Hydrocephalus, 14.

6. — Illustrations of deformities of the pelvis* —

(a) From rickets, 15, 16, 17, 18, 19.

(b) From malacosteon, 20.

(d) “ Masculine ” distortion, 24.

(e) Kyphotic distortion, 25.

II -WAX MODELSf—

1. — Diseases of the skin —

(a) Papulae, 1, 2.

(b) Squamae, 3, 4, 5, 6.

(r) Exanthemata, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18,
19, 20, 21, 22.

{d) Yesiculse, 23, 24, 25, 26, 27, 28, 29, 30, 31.

(e) Pustulae, 32, 33, 34.

( f) Tubercula, 35, 36, 37, 38.

(ry) Parasitici (dermatozoic and dermatophytic diseases), 39
40, 41, 42.

(b) Syphilodermata, 43, 44, 45, 46, 47, 48, 49, 50.

2. — Tumours and morbid growths, 51, 52, 53, 54, 55, 56 57 58

59, 60, 61, 62, 63, 64.

3. — Miscellaneous, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 76

77, 78, 79, 80, 81, 82. 83, 84. ’ ’

• The majority presented by Professor D. Stewart
t Modelled by Mr. Josh. Towne, of Guy’s Hospital, London.

APPENDIX A.

684

III.— PATHOLOGICAL DRAWINGS*—

1. — Diseases of the bones and joints —

(a) Osteomyelitis, 1, 2.

(b) Spontaneous dislocation in disease, 3.

( c ) Melanotic carcinoma, 4.

(d) Rickety distortion, 5.

(e) Gouty distortion, 6.

2. — Diseases of the muscles —

(a) Pseudo-hypertrophic paralysis, 7.

3. — Diseases of the heart and arteries —

(a) Pericarditis, 8.

(b) Endo-carditis and valvular disease, 9, 10, 11, 12, 13, 14,

15, 16, 17, 18.

( d ) Malformations of the heart, 22, 23, 24.

(e) Acute endo-arteritis (syphilitic), 25.

(/) Chronic endo-arteritis (atheroma), 26.

(g) Aneurism, 27, 28, 29.

4. — Diseases of the lungs —

(a) Tuberculosis, 30, 31.

5. — Diseases of the brain and spinal cord—

(a) Haemorrhagic lesions, 32, 33, 34.

(b) Acute cerebro-spinal meningitis, 35, 36, 37, 38.

(r) Malarial pigmentation, 39.

(d) Embolism, 40.

(e) Tumour, 41.

6. — Diseases of the stomach and intestines —

(a) Effects of arsenic poisoning, 42, 43, 44.

(J) Ulceration— gastric, 45.

enteric (in typhoid fever), 46, 47, 48.

(in dysentery), 49, 50, 51.

(d) Perforation, 54.

( e ) Volvulus, 55.

(/) Morbid growths, 56, 57.

7. — Diseases of the liver —

(a) Abscess, 51, 58, 59, 60, 61, 62, 63 (perihepatic).

(b) Carcinoma, 64, 65, 66, 67, 68, 69 (melanotic).

(d) Fatty degeneration, 72.

8. — Diseases of the spleen—

(a) Haemorrhagic infarctions, 73, 74.

\b) Abscess, 75.

* Drawn and painted by Babu Hurrish Chunder Khan, Museum Draughtsman.

APPENDIX A.

685

9.— Diseases of the kidney —

(a) Congestion (active and passive), 76, 77, 78, 79.

\b) Haunorrhagc, 80, 81, 82.

(d) Tubular nephritis, (“large white kidney ”), 84.

(e) Cystic degeneration, 85, 86.

(/) Malformation, 87.

10. — Diseases of the scrotum and prepuce—

(a) Elephantiasis, 88,* 89f, 90, 91, 92, 93, 94, 95+.

11. — Diseases of the uterus and appendages —

(a) Carcinoma, 96, 97, 98.

(b) Dropsy of Fallopian tubes, 99.

12. — Diseases of the skin —

(a) Leprosy, 100, 101, 102, 103.

(b) Morphoea alba, 104.

(d) Syphilitic, 108, 109.

(e) Mycetoma, 110, 111, 112.

(/) Aihuum, 113.

13. — Tumours and morbid growths —

(a) Sarcoma, 114, 115, 116, 117, 118.

(b) Fibroma, 119, 120, 121, 122, 123, 124, 125.

( c ) Lipoma, 126.

(d) Enchondroma, 127, 128, 129, 130, 131, 132.

( e ) Osteoma, 133, 134.

( f ) Adenoma, 135.

(rj) Carcinoma, 136, 137.

14. — Congenital diseases and malformations —

(a) Hcrmapkrodism, 138.

(b) Shapeless conception 139.

I- — PLASTER CASTS AND EARTHEN MODELS.

1. A plaster of Paris cast of the anterior aspect of the thorax of a
young (adult) European seaman who “ stated that, about a year
ago, lie fell off a ship’s yard and fractured ten ribs ; that he
was for some time in hospital after the accident, and recovered
with this deformity.”

“ The heart was not displaced ; the sounds were normal. His lun^s
were healthy.”

The deformity consists of a prominent rounded ridge or projection on
the right side of the thorax, extending vertically from a little
above the level of the nipple to the costal arch, and in a line
with the inner third of the corresponding clavicle. The lower
ribs and intercostal spaces, below the right nipple, are abnormally

* Before operation. | t After operation. | j Noevoid variety.

68G

APPENDIX A.

flattened, and, apparently, approximated ; those above the nipple
are unusually prominent and expanded.

Presented by Dr. S. C. Mackenzie, Presidency General Hospital.

2. A plaster cast of the stump after Syme’s amputation at the ankle-

joint, for carious disease of the tarsus, of five months’ duration.

“ The patient, a Mahomedan (Abdoolla), aged 30, was admitted on the
29th October; operation on 6th November; discharged on 5th
January.”

Presented by Professor S. B. Partridge.

3. The cast of a stump after Syme’s operation. The patient was an

East Indian girl, aged 14, who had long suffered from caries of
the tarsal and metatarsal bones of the left foot, resulting origin-
ally from an injury.

The flaps had united completely by the twelfth day after the operation.
Presented by Professor S. B. Partridge.

4. Angular curvature of the spine. The deformity is well marked,

and situated at about the centre of the dorsal region. No
history.

5. <c Diffused aneurism of the aorta, penetrating the walls of the chest.

From a young East Indian (male, adult). The patient left the
hospital ; result not known.”

A smooth rounded swelling is represented, about two inches below the
episternal notch, and a little to the left of the median line of the
sternum — which seems to have been penetrated.

Presented by Professor Norman Chevers.

6. Aneurism of the ascending aorta, penetrating the chest-wall, and

forming a prominent rounded swelling, the size of an orange,
close to the right border of the sternum. It occupies the first
two intercostal spaces, and projects beneath the soft parts in
this situation. No history. . _ . .

7. Aneurism of the descending portion of the thoracic aorta, pointing

between the ribs in the left infra-scapular region posteriorly.
From a native male, adult. The sac ruptured into the pleural
cavity, and the death of the patient, from haemorrhage, was
sudden and rapid.

Presented by Professor Norman Chevers.

8 9 Psoriasis palmaris et plantaris. Casts of the right hand and
left foot of, apparently, a native adult, representing a very
remarkably fissured and thickened condition of the skin,—
probably syphilitic psoriasis. No history.

10. A plaster cast of a small portion of -skin of a native patient,
affected by, apparently, molluscum — mollascum fibrosum. One
large semi-pendulous tumour, and a great many smaller ones are
seen thickly distributed over the surface. No history.

II A cast of the anterior portion of the thorax of, apparently, a
youno- native lad, exhibiting multiple, subcutaneous growths,
situated almost symmetrically over the. ribs on either side of the
sternum, and over the acromial ends of theclavicl.es. A solitaiy
growth, about the size of half a walnut, occupies the anterior
surface of the manubrium, just below the episternal notch, and
another larger but flattened tumour is situated a little below

ArPENDIX A.

C87

the ensiform cartilage, in the median line. No history recorded.
The growths were, probably, osseous or enchondromatous.

12. Elephantiasis scroti et preputii. A bronzed clay model of

“ elephantoid ” thickening of the skin of the scrotum and
prepuce in a native.

13. Another cast of the same condition affecting the scrotum and

penis of a native, but with the addition of irregularly rounded
swellings in the right groin — probably enlarged lymphatic glands,
and a large smooth swelling in the left groin, just above
Poupart’s ligament, — probably a suppurating bubo, or a bubono-
cele. No history.

14. Cast of a young native child with hydrocephalus. The posture

of the child when sitting, and the manner in which the enlarged
and heavy cranium was supported,, are well represented. The
head has a circumference of 21 inches ; measures 13| inches
from the root of the nose to the occiput (antero-posterior
diameter), and 1H inches from one mastoid process to the other,
across the vertex.

15. Cast of a female pelvis deformed by rickets. The pubic bones

are pressed backwards and flattened, the promontory of the
sacrum projects unduly forwards, and the brim is thus much
contracted in its conjugate diameter.

The measurements are —

Antero-posterior.

Transverse.

Oblique.

Brim ... ... 2"

ri'i

41"

Outlet ... ... 2 a7

16.

Rickety deformity of the pelvis ; measurements —

Antero-posterior.

Transverse.

Oblique.

Brim ... ... li"

4±"

-*■ 5

Outlet ... ... If"

42."
**■ 6

17.

Greatly deformed pelvis from rickets. The measurements are-

Antero-posterior.

Transverse.

Oblique.

Brim ... ... tV

di-"

Outlet ... ... 2|"

18.

Moderate rickety deformity of the pelvis.

The measurements are —

Antero-posterior.

Transverse.

Oblique.

Brim ... 2\"

41 "

Outlet ... 3'

19.

Rickety deformity of the brim of the pelvis, but

with an

normally wide outlet.

Measurements —

Antero-posterior.

Transverse.

Oblique.

Brim ... 2 17

41"

4\"

Outlet ... 41"

688

APPENDIX A.

20. A clay model of a morbidly contracted pelvis the result of
malacosteon. The transverse diameter at the brim is reduced,
the rami of the ischium and pubes are abnormally approximated,
rendering1 the pubic angle acute, and greatly diminishing the
outlet, which is further narrowed by the projection forwards of
the coccyx. The measurements are —

Antero-posterior. Transverse. Oblique.

Brim ... 31" 41" 4 .a."

Outlet ... 33" 2''

21. A model, of oblique distortion of the pelvis. There appears to be
ankylosis of the left sacro-iliac synchondrosis, with defective
development . of the corresponding half of the sacrum. The
pelvis is twisted to the right ; the right oblique diameter
shoitened, the left increased. The exact measurements are —

22.

Antero-posterior. Transverse. Right oblique.
Brim ... 4" 4"

Outlet ... 4a" 9 a"

5 6

Left oblique.

rci "
O 1 o'

Another model of oblique distortion of the pelvis. Measure-
ments—

23.

Antero-posterior. Transverse. Right oblique.

Brim ... 2 1" 4Ty 3*"

Outlet ... 4 a" 4t«_"

Left oblique.
4f"

Oblique distortion with contraction of the pelvis from a young
native female, who died in the obstetric wards of the Hospital.
She was delivered by cephalotripsy, but died from exhaustion a
few hours after. The measurements are —

Antero-posterior. Transverse. Right oblique. Left oblique.

Brim ... 3i" 3i" 4TV'

Outlet ... 3£" 2|"

Presented by Professor R. Harvey.

24. “ Deformed pelvis from a Hindu female, aged 30. The patient

had lateral curvature of the spine (as shown by the last two
lumbar vertebrae). The outlet has a cordate appearance” (Colles).
This pelvis approximates in build to that of the male. It is
characterized by the rotundity of the brim, the depth of the
cavity, the unusual concavity of the sacrum, and by the
narrowing of the outlet, owing to the contracted angle formed
by the pubic arch. The measurements are —

Antero-posterior.

Transverse.

Oblique.

Brim

42."

...

4A"

Cavity

43"

...

3|"

Outlet

02"

Presented by

Moulvic Tameez Khan, Khan Bahadoor.

APPENDIX A.

G89

25. Model of a kyphotic pelvis. This peculiar deformity is ap-
parently clue to backward curvature of the lumbar spine, whereby
the promontory of the sacrum is greatly diminished, . and the
conjugate diameter of the brim proportionately increased.
On the other hand, the outlet is diminished by the approximation
of the ischial tuberosities, and especially by the abnormal forward
curvature of the coccyx. The measurements are

Antero-posterior. Transverse. Oblique.

Brim ... 4f" 5*w 5f

Outlet ... 2i" 3 k"

II. — WAX MODELS.

1. Lichen circumscriptus. — The inner and anterior aspects of the
thigh are covered with little reddish or pinkish papules, collected
so as to form rounded elevated patches of limited but varying
diameter.

The appearance closely resembles that of tinea circinata, so common in
this country, but which is parasitic in origin.

2- Prurigo. — A portion of the arm and forearm showing slightly
elevated smaller and larger papules of a dusky pink colour.
Numbers of them are represented with minute scabs or dried
blood-stains, to indicate, probably, the results of scratchings,
intense pruritus being always associated with the disease.

3. Psoriasis or lepra alphoides. — The back of the arm and forearm
with small circumscribed patches of bright pink colour, covered
with minute silvery scales ; where the latter have dropped oil
the raw bleeding cutis vera is exposed.

4- Lepra nigricans. — Large, scaly, slightly raised patches of a dark
brown colour affect the skin on the anterior aspect of the leg,
while the scars left by the healing of such patches may be
observed just below the knee-joint. A form of psoriasis or lepra
met with in individuals with weakly or broken-down constitutions,
or the subjects of strumous or syphilitic cachexia.

5. Fsoriasis labialis. — A cracked and fissured appearance of the lips,
especially at the angles of the mouth, is represented, with small
furfuraceous scales at their margins, and over the intermediate
inflamed and swollen skin.

6- Psoriasis chronica vel inveterata. — On the dorsum of the wrist and

hand there are patches of greatly fissured and thickened cuticle.
The fissures in several places, e. g., over the knuckles, are deep-
red and raw-looking. The unaffected skin is abnormally
hypersemic and injected.

7- Rubeola (measles). — The chest and abdomen of a child are

represented, covered with the characteristic dusky-red, slightly
raised eruption, assuming a more or less crescentic or serpiginous
outline, enclosing small spaces of skin which have a normal
appearance and colour.

8. Urticaria. — Small and large raised wheals or phomphi are seen,
— rounded, oval, or irregular in outline, of whitish colour, and
surrounded by hyperaemic zones of congested, bright-red skin.

690

APPENDIX A.

9- Erythema nodosum. — Raised circumscribed patches of bright-red
colour are observed over the skin on the anterior aspect of the
leg. The largest, over the shin, is oval in shape, four inches
in length by three in breadth, — the long diameter parallel to
that of the limb. At the margins of the patches the colour
is not so bright, has a yellowish tinge, and fades away into the
natural hue of the unaffected skin— like a bruise.

10. Erysipelas.— The whole of the face, and particularly the left side,

including the ear, is affected. The skin presents a very bright-
red colour, is swollen, glazed, and puffy. Over the upper lip,
at the margins of the nostrils, blebs have formed and burst,
leaving a yellowish purulent exudation.

11. Varicella (chicken-pox). — The right lower limb of an infant, with

scattered, small, transparent vesicles. (An old preparation, and
not good).

12. Purpura.— Small points, patches, and larger bruise-like discolour-

ations of the skin of the thigh and leg are represented. They
have a pinkish, purplish, or bluish colour, and are all the result
of limited blood-extravasations into the structure of the cutis
vera.

13. Abdominal typhus, or typhoid spots. — Pose-coloured, slightly

raised, soft, circular spots are observed, either discrete, or in
small groups of three or four, over the skin of the abdomen.
They make their appearance between the 8th and J2tli day of
the fever, remain for three or four days and then fade away,
but only to be succeeded by a fresh crop of similar spots, which
follow the same course.

14. Maculae or minute points or spots of skin-staining and dis-

colouration,—commonly met with in the course of many of the
eruptive fevers.

15. V ariola (small-pox). The appearance of the eruption on the

third day of the fever. Scattered over a child’s face are
numerous bright-red, hard, accumulated points, the size of
hemp-seed, with rosy efflorescence of the adjacent and surround-
ing skin.

16. Variola discreta. — The appearance of the eruption on the hand

and forearm of an adult, on the 4th or 5th day of the disease.
Prominent, “ shotty,” large, mostly separate and distinct papules
are observed, and others transforming into vesicles ; both
varieties of eruption being surrounded by bright-red rings of
congestion, and a general erythematous condition of the cuticular
surface prevailing.

17 18. Variola confluens. — Two specimens of the disease, on or about

the 5th and 7th days respectively. The vesicles in the one
case, and the pustules in the other, have run together, and form
large, prominent, semi-transparent or opaque, yellowish blebs,
which thickly cover the entire skin of the hand and forearm.

19. Variola confluens, 9th day. — Complete maturation, with sub-
sidence of the pustules ; dusky-red discolouration of, and in parts
haemorrhage from, the intervening highly congested and in-
flamed skin.

APPENDIX A.

691

20. Vaccinia. — The arm of a child on the third day after vaccination.
A red line or scratch is seen at the site of puncture, which is
slightly raised, tumid, and of a pale-pinkish colour.

21. Vaccinia. — Characteristic appearance of successful vaccination on

the 8th day (fifth of eruption). A prominent umbilicated vesicle
is observed ; the surrounding .skin is raised, slightly indurated,
and of a bright-red colour (the areola), fading gradually, at the
margins, into the natural tint of the healthy skin,

22. Vaccinia. — Appearance from about the 15th to the ISth day.

Hard, dry, dark, and withered scabs now cover the sites of
puncture and eruption. The areolae have disappeared, all signs
of cuticular inflammation have subsided. The crusts are about to
separate, and leave indelible cicatrices.

23. Herpes iris. — The skin of the arm and forearm exhibit circular

hyperaemic patches of a dusky-red colour. At the centre of each
patch is a large vesicle or bulla, which is surrounded by concentric
rings of smaller vesicles, filled with clear transparent fluid.

24- Herpes zoster or zona (shingles). — The eruption affects a limited
space on the right side of the abdomen. Upon a bright-pink
erythematous skin, a crop of small, transparent vesicles, or
larger and slightly opaque bullae, are observed, which form a
kind of transverse belt or band, and are strictly limited to the
area of distribution of the cutaneous nerves in this situation.

25. Herpes circinatus. —Circinate vesicular patches of varying size,
affecting the skin of the shoulder and arm. With these are
small, scattered, separate vesicles, distributed over the course of
the internal cutaneous nerves, in the long axis of the limb.

26 Miliaria (sudamina). — The skin of the thorax, neck, and axilla
is represented covered by innumerable small transparent vesicles.
These make their appearance in a variety of diseases in which
profuse sweating occurs, and, very rarely, constitute a specific
febrile affection, — termed miliary fever.

27- Eczema simplex (vel solare). — Very numerous semi-transparent

vesicles and a few larger bullm are observed thickly distributed
over the dorsum of the wrist and hand, the unaffected skin
being slightly erythematous.

28- Eczema rubrum. — The skin of the neck, back, and chest is highly

inflamed, excoriated, of a raw red colour, and covered with large,
thick, yellowish-brown crusts. Where these have fallen off',
the part is glazed and moist from the copiousness of the discharge
which is always associated with this variety of the disease.

29. Eczema genitale. — The skin of the lower part of the abdomen,

of the inner sides of the thighs, and of the scrotum and
root of the penis, is red and raw-looking, but is also covered with
large, thin, dry seales, and variously fissured and excoriated.

30. Eczema ehronicum. — Chronic eczema of the skin of the leg.

Very large brownish scabs or scales are seen over the skin, and
where these have partially separated, the cuticular surface has
a dull-red, moist appearance. On the inner side of the leg, and
over the skin of the knee-joint, there are large irregular patches
of dark discolouration, indicating the site of healed eczematous

G92

APPENDIX A.

crusts, while, here and there, scattered large vesicles represent
the initiatory stage of a fresh eruption.

31. Eczema impetiginodes. — A form of eczema occurring in debilitated

subjects, especialty children. The crusts are thick and yellowish-
brown ; a large patch is observed over each cheek, and smaller
ones over the left eyebrow and tip of the nose. Isolated
scattered pustules are plentifully distributed over the rest of the
face. The predominance cf the pustular element in the early
vesicles, in the discharge, and in the ultimate crusts, is the
special and distinctive peculiarity of this variety of eczema.

32. Impetigo. — An old and not good specimen. The disease is repre-

sented affecting the skin of the dorsum of the hand and fingers.
Large glazed excoriations and fissures are observed, with thin
brownish crusts and scales, and, over the wrist, a small group of
opaque pustular eruptions.

33. Impetigo contagiosa vel favosa. — Thick, more or less rounded, and

in parts, quite isolated crusts, having a granular and peculiarly
gummy appearance, are seen loosely covering patches of
hypersemic and raw-looking skin over the forehead, cheeks, chin,
and nose of a child. An isolated pustule on the right cheek
represents the earliest stage of this variety of impetigo.

34. Ecthyma (cachecticum). — A pusular eruption affecting the skin

of the face. The pustules are .prominent and isolated, or are
represented as drying up to form small brownish crusts.

35. Lupus erythemat'odes. — The skin of the cheeks and nose presents

a deep-red colour, and shiny appearance, without sensible
elevation. Thin adherent scales cover the affected portions.
The patch is of large size, and irregular or serpiginous in outline.
A smaller patch, in parts slightly tuberculated, is observed
over the forehead. The margins of the patches are highly
vascular, and exhibit numerous small blood-extravasations or
eccliymoses.

36. Elephantiasis Grjecorum (tuberculata). — The face of a man

affected with true tubercular leprosy. The tubercles are of large
size, are isolated or in groups, have a dusky-red or brownish
colour, and affect chiefly the skin of the forehead, nose, lips,
and chin.

37. Elephantiasis Arabum (Bucnemia tropica). — The “ elephant ” foot

and leg of the tropics. The enormously thickened and tuber-
culated condition of the skin, especially over the dorsum of the
foot and toes, is well represented. A large, raw, unhealthy ulcer
is shown on the anterior aspect of the leg, a little above the
ankle-joint.

38- Sycosis (follicular). — The non-parasitic form of follicular inflamma-
tion affecting the skin of the lips and chin. Large tuber-
culated swellings are observed, with numerous stunted diseased
hair-shafts piercing them in various directions. The swellings
have a brownish or yellowish-brown colour, and some of them
are glazed and shiny.

39. 40. Scabies. — Two specimens. In one the left foot of an infant,
in the other the left hand of an adult, are exhibited, with the

APPENDIX A.

693

papular or vesicular eruption produced by the irritation of the
skin, in consequence of the presence of the acarus (A. scabiei).
These are best marked, in the second specimen, on the back of
the wrists, and in the fissures between the fingers.

41. Scabies purulenta. — The hack of the hand and the thin skin

between the fingers are seen covered with a characteristic
vesicular and also pustular eruption, from some of which a sero*
sanguineous discharge is exuding, and there is a good deal of
erythematous redness of the surrounding skin.

42. Favus (tinea favosa). — The scalp of a child is covered with

numerous, rounded, yellowish, cup-shaped crusts, having thick-
ened raised margins, and depressed centres. Each scab or crust is
more or less isolated and distinct ; several are pierced by diseased
hair-shafts ; and a sticky, gummy discharge is seen matting
together the unaffected hair surrounding the favi. A few small
scattered crusts are observed on the back of the neck and right

shoulder. The disease is due to the invasion of the hair
follicles and epidermal epithelium by a specific fungus, — the
Achorion Schonleinii.

43. Lichen syphiliticum. — Dark points or papules are observed,

situated in groups over the skin of the arm and forearm ; some
of them have become almost pustular, others are covered with
small dry brownish scales. The affected skin has a dull-red
colour, and there are numerous maculae or pigmentary stainings
interspersed among the papular elevations.

44. Psoriasis palmaris. — There is bright erythematous redness of the

skin, with numerous dry fissures and cracks, and brownish
scales. Towards the centre of the palm, the latter (scales) are
thin, delicate, and shiny. The disease is almost invariably
syphilitic.

45. Lepra syphilitica. — Small isolated patches, having a distinctly

coppery tinge, and covered with thin, gray, shiny, epithelial scales,
are seen over the arm and forearm. The majority of the
patches have a whitish circumferential line, due to the elevation
and detachment of the cuticle.

46. Syphilitic maculie. — Dark, copper-coloured, pigmentary stainings

of isolated and circumscribed character, affecting the skin of the
arm and forearm. These frequently succeed scaly and other
specific eruptions, and are often very persistent.

47. Kupia ( syphilitica). — On the right side of the nose, on the fore-

head, and over the left cheek characteristic “oyster-shell,”
stratified crusts are observed. Two of these are large and
prominent (It. prominens) ; the others are smaller and flattened
(It. simplex). They have a brownish-red colour, and, at their
margins, the subjacent skin is seen to be inflamed and highly

48. Syphilitic ecthyma. — The skin of the arm and forearm is covered
with scattered dark pustules, having a coppery base. With
these are numerous dark-brown crusts with thickened raised
margins, and flattened centres, or are prominent, imbricated and
rupial-like.

694

APPENDIX A.

49. Ecthyma syphiliticum affecting a hairless scalp. Scattered pustular

elevations and unhealthy-looking ulcers are observed. The
latter are sharply defined, have coppery-coloured bases, and are
covered with a sero-purulent discharge, which, in some instances,
has dried to form gummy yellowish crusts.

50. Congenital syphilis. — The skin of* the soles of the feet, of the
buttocks, and especially of the peri-anal region of a young
infant, exhibits a reddish erythematous appearance. There are
thin scaly patches and excoriations over the nates, and dry
fissures at the inner sides of the thighs. Scattered brownish
maculae, smooth or slightly scaly, are observed over the back.

51. Scirrhus carcinoma of the mamma. — The nodulated and indurated

appearance of the gland is shown, with retraction of the nipple,
and lateral extension of the morbid growth into the right axilla.

52. Fungating carcinoma of the female breast. — Ulceration of the skin

over a large space has taken place, with protrusion of exuberant
highly vascular cancerous nodules. The whole of the mamma
is affected, and secondary lymphatic indurations are represented
in the left axilla and above the clavicle.

53. Scirrhus cancer of the male breast. — The gland is enlarged and

indurated. It is surrounded by flattened nodules of morbid
growth, and the skin generally has a dusky-red appearance, with
much injection, in patches, of the superficial capillary vessels.

54. F ungus hrematodes (enkcphaloid cancer) of the left orbit. — The

whole of the eyeball has been destroyed ; the eyelids and adjacent
soft parts have ulcerated, and, through them, a highly vascular
fungoid growth protrudes, which presents, as an irregularly rounded
mass, the size of a small orange.

55 Enkcphaloid carcinoma of the left orbit. — The eyeball has been
destroyed ; the eyelids have ulcerated and sloughed ; a large
irregular-outlined ulcer, with indurated and eroded margins,
occupies their place. The morbid growth is extending in
various directions ; — it infiltrates the soft parts of the cheek ; forms
a rounded prominent swelling at the outer angle of the orbit ;
soft, smooth, nodular excrescences beneath the skin of the forehead ;
and has made its way into the nares and opposite orbit, causing
protrusion of the right eyeball, and destructive inflammation of
the structures of the globe.

56. Carcinoma of the eyeball.— A longitudinal section, showing the

pale-pinkish, soft-looking, brain-like appearance of the morbid
growth diste nding the sclerotic, and pressing upon and pro-
ducing gradual destruction of all the other structures of the
globe.

57. Melanotic sarcoma or carcinoma of the left orbit.— A dark fungoid

protrusion of the eyeball and surrounding structures is repre-
sented. The eyelids are greatly stretched and thickened, but
are not ulcerated, and still enclose the protruding mass. Swell-
ing, induration, and dusky-red discolouration of the left parotid
gland coexists.

58. A vertical section of an eyeball affected by melanotic sarcoma or

carcinoma, showing the origin of the morbid growth from the

APPENDIX A.

695

sheath of the optic nerve and posterior part of the sclerotic coat ;
its softly tabulated and dark pigmentary structure ; and the
complete destruction of the contents of the globe of the eye.

59. A malignant growth — probably sarcoma — affecting the right orbit

and the nostrils, forming a huge, lobulated, subcutaneous tumour,
and producing hideous deformity of the face.

60. Malignant ulceration of the face (epithelioma). — The right half
of the face and a portion of the neck are seen involved. The
margins of the ulcer are prominent, irregular, indurated, and
eroded. The surface exhibits numerous highly vascular nodules
and excrescences of fungoid character. At the upper part, just
below the orbit, there is a large bloody eschar ; and the sur-
rounding unaffected skin presents a dusk-red or purplish colour.

61. Malignant (epitheliomatous) ulcer of the dorsum of the hand.

It involves the skin and subcutaneous soft parts down to the
bones ; is deeply excavated in parts, in others fungoid looking ;
the margins are greatly thickened, eroded and vascular. The
surrounding unaffected skin shows dusky-red discolouration.

62. A prominent, fungoid, and highly vascular growth, affecting the

skin and soft parts on the front of the leg, — probably epi-
thelioma.

63. A hard horny growth, flattened and curved towards its distal

extremity, developing from the skin at the back of the forearm,
a little above the wrist-joint.

64. Carcinoma of the pylorus. — A series of irregular, indurated nodules

are represented, surrounding the pyloric orifice of the stomach,
and greatly constricting its channel. The mucous membrane
covering them is highly vascular and injected. Two nodules
have been incised to show the greyish-yellow appearance of the
morbid growth.

65. Gastic ulcer. — At the lesser curvature of the stomach, near the

pylorus, a circumscribed sharply defined ulcer is seen, about the
size of a four-anna piece (six-pence). The margin is abrupt and
smooth; the surface has an ash-grey colour (sloughy). The
general mucous membrane of the organ is thickened, swollen,
and intensely vascular.

66. 67. Two specimens of the stomach after poisoning by arsenic.

The mucous membrane is seen to be highly corrugated, inflamed,
and exceedingly vascular. Dark purplish ecchymoses, and small
superficial ulcerations may also be observed in parts.

68. The stomach after poisoning by oxalic acid. — The mucous mem-

brane has been completely removed from a large portion of the
inner surface of the organ, below the lesser curvature. The
sub-mucous coat is exposed, and presents very numerous, largo,
dark, ramifying, dilated, capillary vessels, and patches of purplish
ecchymosis and blood-extravasation.

69. Anthrax or Carbuncle. — A large but circumscribed and indurated

swelling is represented, having a dark or dusky-red colour
towards the centre, which shades off into the surrounding healthy
skin at the circumference. The skin over the swelling has a
glazed or “ brawny ” appearance ; is seen perforated at several

696

APPENDIX A.

points by small openings, through which whitish “ cores ” are
visible ; while, at the centre, it has given way over a larger space,
through which thick sloughs of the cellular tissue are protruding,
and a sanious and purulent discharge.

70. Anthrax or Carbuncle, after crucial incision. The enormous

inflammatory thickening of the subcutaneous cellular tissue, its
excessive vascularity, and infiltration with pus, are all well seen
in this model.

71. Dry gangrene affecting the left hand and wrist.— The shrivelled,

mummified, and darkly discoloured condition of the diseased
parts is remarkably well displayed, as also the circle of ulceration
— “ line of demarcation ” — between the living and dead tissues.

72. Phagadtenic ulceration of the forearm. — Two large, and several

smaller ulcers are shown, with irregular but abrupt margins,
and deeply excavated sloughy surfaces (probably syphilitic).

73- Erysipelatous ulceration of the dorsum of the hand, said to be the
result of “ glanders.” — An oval-shaped ulcer is observed, with
hard, irregular, dark-purplish margins, and a sloughy tuber-
culated surface.

74. A wax model illustrating the appearance of varicose veins in the

leg, and the presence of several indolent (varicose) ulcers, a little
above the ankle-joint. The whole limb presents dusky livid dis-
colouration of the skin.

75. A wax model described as illustrating “ melanosis of the leg.”

76. Cirrhotic or “ hob-nail ” liver. — The shrunken and contracted con-

dition of the organ, and its remarkably tuberculated and nodulated
surface, are very well represented.

77. “ Large white kidney” of Bright — tubular nephritis. The hyper-

trophied condition of the organ, its smooth surface, and pale-
pinkish colour are readily recognisable. The capsule is represented
as being partially peeled off, and as separating easily.

78. A series (twelve) of small wax models, in a separate case, illustrat-

ing various conditions of the os and cervix uteri, e.g., hyper-
trophy, warty growths, follicular inflammation, malignant
ulceration, &c.

79. 80. 81. Three wax models of the “ lactating ” female breast at

the sixth, seventh, and ninth months, respectively, of utero-
gestation or pregnancy. The comparative enlargement, plump-
ness, and vascularity of the mamma at these periods is intended
to be represented, as also the dark discolouration of the areola
round the nipple, the prominence of the superficial veins, tur-
gescence of the nipple, and other characteristic signs.

82. 83. 84. Three wax models intended to illustrate the relative

size, colour, position and other characteristics of the lungs of the
foetus (a) prior to respiration, ( b ) when respiration has com-
menced, and ( c ) when respiration has been fully established.

III.— PATHOLOGICAL DRAWINGS.

1. Osteomyelitis of the humerus, a vertical section of the bone. — The
medullary canal is seen to be acutely inflamed, and, as well as the

APPENDIX A.

097

cancellous tissue of the head of the bone, presents a bright
cherry-red colour. From a Mahomedan male, who died in hospital.

( See further, Surgical Post-mortem Records , vol. I, 1877, pp. 402-3).

2. Osteomyelitis of the upper half of the left femur, following

amputation of the thigh for compound fracture. — There is denud-
ation of the bone, from loss of periosteum, for about two inches
above the level of the stump, and a highly vascular, inflamed, and
putrid condition of the medulla and cancellous tissue of the head
and trochanters.

Case of a native male, aged 30.

( See further, Series II, prep. No. 118, p. G7).

3. Spontaneous dislocation backwards and outwards of the leg (tibia)

from the thigh (femur), the result of chronic disease and disorgan-
ization of the right knee-joint. — Case of a hospital patient (native
male), aged 40. ( See further, No. 51, Series III, p. 94.)

4. Melanotic (enkephaloid) carcinoma of a rib. — Nodular, dark,

pigmentary deposits are seen, with spontaneous fracture of the
bone at these spots. From an East Indian (male), aged 44.

( See also Series II, prep. No. 62, p. 58.)

5. Rickety distortion of the spine and thorax.

6. The hand of a middle-aged European (male) showing very charac-

teristic gouty distortion of the fingers.

7. Pseudo-hypertrophic paralysis .(Duchenne’s) of the flexors of the

forearms and legs. There ' is also a marked curvature of the
spine, from atrophy of the erector muscles. Case of a native
(Hindu) boy, aged 12, an in-patient.

8. Acute pericarditis (early stage). — The vividly injected and highly

vascular condition of both parietal and visceral layers of the
pericardium are well represented, and the presence of yellowish
lymphy deposit on the surface of the heart.

9. Acute endocarditis. — Stenosis of the mitral orifice by recent warty

vegetations. Ante mortem , fibrinous, hollow or solid growths
(thrombi) in the right auricle.

10. Acute ulcerative endocarditis and myocarditis ; perforation of

the left coronary valve, &c. From a native male, aged 26.

(See prep. No. 37, Series VI, p. 121).

11. Warty vegetations of the pulmonary and tricuspid valves. — From

a native female, aged 24^, who died in hospital.

(See Medical Post-mortem Records, vol. I, 1875, pp. 859-60.)

12. Inflammatory (atheromatous) thickening, Assuring, and rupture

of the aortic valves. — From a native male, aged 35.

13. Great thickening, crumpling, irregularity, and partial cohesion

of the coronary valves (aortic insufficiency). There is slight
atheroma of the aorta, and dilatation of the left ventricle. Case
of John Hopkins, an African seaman, aged 57.

(See further, Medical Post-mortem Records, vol. II, 1877, pp. 369-70.)

14. 15. Chronic endocarditis of the right side of the heart, and

extensive disease of the pulmonary artery — (two plates, showing,
respectively, the anterior and posterior views of the lesions).
From a Hindu, aged 38, who died in hospital.

( See further, prep. No. 226, Series VI, p. 163.)

G98

APPENDIX A.

16. 17. Aneurism of the mitral valve. — Two plates, A and B,
showing, respectively, the appearance of the little pouch from
the ventricular and from the auricular aspects.

(See further, prep. No. 129, Series VI, p. 143.)

18. The left ventricle of the heart, showing the rupture of a hollow

growth or aneurism of the middle flap of the aortic (coronary)
valves. " '

19. An enormous decolourised and partially organised ante mortem

fibrinous dot or cardiac polypus, firmly adherent to the wall
ot the right auricle, and depending into its cavity.

(For description and microscopic structure, see prep. No. 137 Series
VI, p. 145.)

20. An ante mortem globular thrombus, the size of an English plum.
It is attached to the apex of the right ventricle, and to the
posterior and inferior flaps of the tricuspid valve. At one spot
it has ruptured, displaying its hollow structure. From a native
male, aged 38, who died of pneumonia.

( See prep. No. 147, Series VI, page 147.)

21. A very large globular thrombus, or dendritic, ante mortem , fibrinous

vegetation, attached firmly to that portion of the auricular wall
which lies between the superior and inferior caval openings. It
is the size of a hen’s egg. The upper part is rounded and
smooth where it has projected into the appendix auriculae ; the
lower part is broader, and, in this situation, the thrombus was
found to have softened and given way, discharging its yellowish-
white creamy contents into the auricle and ventricle. From a
native male, aged 40, who died of cirrhosis of the liver, &c.

(See prep. No. 148, Series VI, page l4i7).

22. Congenital perforation of the septum ventriculorum, — Prep.

No. 152, Series VI, page 148. From a native woman, aged 20,
who died of pneumonia after child-birth.

23. Congenitally malformed and hypertrophied heart. — The aorta and

pulmonary artery both originate in the right ventricle; the
septum ventriculorum is perforated ; the left auricle is rudimen-
tary, &c. For full description, see prep. No. 153, Series VI,
page 149.

From a Hindu female, aged 18, who died in hospital.

24. Congenital fenestration of the aortic and pulmonary valves,— a

series of nineteen separate drawings from different subjects.

25. Acute endo-arteritis (syphilitic). — The lining membrane of the

aorta, just above the coronary valves, presents irregular, pale-
pinkish thickening, which, in the fresh state, was moderately soft
or gelatinous, and confined entirely to the inner fenestrated coat.
From a native male, aged 25, who died of pneumonia. There
was a history of constitutional syphilis, and rupial scars over the
arms and legs.

26. Atheromatous degeneration of the arch of the aorta, in parts

advanced to calcareous infiltration, and the formation of large,
irregular, yellowish, hard plates, which lie very superficially on
the inner surface of the vessel. From a native female, aged 55.

APPENDIX A.

699

27. Aneurism of the abdominal aorta, the size of a hen’s egg, taking,

its origin at the root of the superior mesenteric artery.

Found on post mortem examination of a European, aged G5, who died
in hospital from acute pulmonary tuberculosis.

( See prep. No. 291, Series VI, page 188.)

28. 29. Two plates illustrating the appearances presented by a

remarkably large diffused aneurism of the abdominal aorta,
surrounding the left kidney, and proving fatal from rupture into
the pleural cavity.

Case of F. Pallerini, an Italian seaman, aged 42.

( Sec prep. No. 293, Series VI, p. 189, and Medical Post-mortem
Records , vol. II, 1877, p, 543-44.)

30. Acute diffuse miliary tuberculosis of the lung. From a native
male (adult), who died in hospital.

31. The apex of the right lung, illustrating the so-called “ obsolescence

of tubercle.” A vertical section is represented. One large and
several smaller cheesy nodules are seen, (lying just beneath a
thickened and puckered condition of the pleura), and there is
condensation, fibroid thickening, and pigmentation of the sur-
rounding pulmonary tissue.

(See prep. No. 86, Series VII, p. 225.)

32. A large sanguineous cyst o£ the arachnoid, completely covering

the upper surface of the right cerebral hemisphere. Case of
Pedro Visconti, a Malay, who died from epilepsy.

(For description and history, see prep. No. 48, Series VIII, p. 256.)

33. Acute red softening of the left corpus striatum. From a native

male, aged 30, who died from chronic empyema. Multiple, small,
circumscribed spots of similar softening were found in other
parts of the brain, — particularly in the cortex.

(See further, prep. No. 12, Series VIII, p. 247.)

34. Punctated ecchymosis (miliary apoplexy) of the brain. From a
case of scorbutic dysentery— a European seaman, aged 62.

35. 36. 37. Acute cerebro-spinal meningitis. Three coloured plates

showing, respectively, the appearance presented by (a) the upper
surface of the brain, (b) the base of the brain, and (c) the spinal
cord. In all three instances there is waxy-looking opacity of the
membranes from recent sero-fibrinous effusion, and an abnormally
injected and varicose condition of the blood-vessels.

Case of a native male, aged 27, who died on the ninth day of the
disease. (Medical Post-mortem Records, vol. 1, 1S73, pp. 103-4).

38. The spinal cord and membranes, from a similar case (acute

meningeal inflammation).

39. Malarial pigmentation of the brain. Sections from the cerebrum

and cerebellum, showing a dark leaden appearance of the grey
matter of the convolutions, and a dusky discolouration of the
white substance. With these arc drawings of sections from the
spleen and liver, exhibiting also very dark pigmentation.

(See further, preps. No. 29-34, Series VIII, pp. 251-52.)

40. The circle of Willis, showing a firm decolourised fibrinous clot
impacted in the basilar and vertebral arteries. From a native
male patient, a ejanja-smolcer , aged 45, admitted into hospital

700

APPENDIX A.

with symptoms of apoplexy. The attack was sudden, — com-
menced with convulsions, and gradually passed into coma, in
which state the man died.

( See prep. No. 73, Series VIII, p. 263.)

41. A fibro-papillary growth (psammoma), about the size of a nut-

meg, attached to the free margin of the falx cerebri. Found on
post mortem examination of a native female, aged 50, who died
of dysentery.

(See further, prep. No. 66, Series VIII, p. 261.)

42. Acute inflammation and softening of the mucous membrane of

the stomach, from a case (a native female patient) of poisoning
by yellow arsenic. Many of the metallic particles are seen
still adherent to the surface.

43. The stomach and duodenum from a case of arsenical poisoning.

There are scattered patches of bright red vascularity and softening
of the mucous membrane, and to some of them may be seen
adhering minute yellow particles of the metal.

(See further, prep. No. 24, Series IX, p. 2S3.)

44. Another coloured drawing of the inner surface of the stomach

from a case of poisoning by arsenic, showing the intense vascu-
larity and corrugation of the mucous membrane, and the
presence of a large amount of the poison, in the form of yellow
adhering particles.

45. Minute pigmented ulcers (erosions) of the mucous membrane of

the stomach. From a native male, aged 40, who died of acute
dysentery, complicated with gastritis.

(See further, Medical Post-mortem Records , vol. II, 1878, pp. 859-60.)

46. A portion of the ileum (with the coecum) from a case of true

typhoid or enteric fever, a Goorkha sepoy, aged 22, who died
on the twelfth day of the disease.

(See prep. No. 96, Series IX, p. 302.)

47. The coecum and about three feet of the ileum showing enormous

fungoid prominence, vascularity, and infarction of the patches of
Peyer and solitary glands, with also superficial sloughing of
portions of the former. The mesenteric glands are seen enlarged,
swollen, and hyperaemic. From an Armenian child, aged seven
years, who died in hospital of typhoid or enteric fever.

(See prep. No. 98, Series IX, p. 303.)

48. Tumefied and partially ulcerated patches of Peyer and solitary

follicles at the lower end of the ileum. From a European male
patient, aged 30, who died in hospital from typhoid fever, while
undergoing treatment for popliteal aneurism.

(See further, prep. No. 94, Series IX, p. 301.)

49. Scorbutic dysentery. A portion of the descending colon, sigmoid

flexure, and rectum showing intense ecchymosis and superficial
ulceration of the mucous membrane, and large irregular circum-
scribed blood-extravasations beneath the peritoneal coat..

50. The appearance of the small intestine in the same disease

(scorbutus or scurvy). Large blood-extravasations are seen
immediately beneath the peritoneal coat of the small intestine
(ileum).

APPENDIX A.

701

51. A portion of the large intestine and the liver of a native male

(Hindu), aged 24, who died in hospital. The former exhibits
much chronic ulceration, thickening, and cicatricial contraction
in the coecum ; a large old ulcer near the hepatic flexure of the
colon ; and recent acute dysenteric changes throughout the rest
of the gut, which is covered, at the seat of both old and recent
lesions, with granular opaque fibrinous exudation (lymph). The
liver shows numerous, recent, mostly small and circumscribed
abscesses, projecting slightly from the surface, and surrounded
by distinct bright-pink zones of vascular congestion.

(See further, Medical Post-mortem Itecords, vol. Ill, 1880, pp. 587-88).

52. 53. T wo coloured plates showing, respectively, a darkly punctated

appearance of the patches of Peyer (plaques pointilles) in the small
intestine, — commonly found in cholera, acute diarrhoea, and other
diseases associated with follicular irritation of the bowel ; and a
similar condition of the colon, — frequently met with in chronic
dysentery, &c.

54. Perforation of the duodenum by a round worm (Ascaris lumbri-
coides) .

Case of a native female, aged 30, who died from acute general peri-
tonitis, the result of this accident. (See prep. No. 151, Series IX,
and Medical Post-mortem Itecords, vol. II, 1878, pp. 473-74).

65. Volvulus or twist of the large gut (sigmoid flexure and portion
of descending colon), with consequent strangulation, and death
from obstruction of the bowels and peritonitis.

(Prep. No. 182, Series IX, p. 321).

56- Hodgkin’s disease or lymphadenoma. — The ileum, mesenteric
glands and spleen, all exhibiting morbid lymphoid infiltration
and nodular deposits. From an East Indian woman, aged 25,
who was brought into hospital in a moribund condition, and
died, within 24 hours of admission, with no definite symptoms
but those of great exhaustion and collapse.

(For further description, see preps. No. 259, Series IX, p. 333, and
No. 68, Series X, p. 375).

57- Multiple glandular growths (tubular adenomata) of the stomach.

The case of an American (ship-captain), who died in the General
Hospital.

(For description and history, see prep. No. J82, Series XVII, p. 580).

58. 59- Small multiple abscesses of the liver, — appearance on the
surface, and on section of the organ. From a native male patient,
aged 24, who died in hospital of acute dysentery.

60. Multiple pysemie abscesses of the liver. From a native male
(Hindu), aged 25, admitted into hospital with chronic dysentery.

(For further description, see prep. 302, Series IX, p. 342.)

61. Multiple abscess of the liver (pytemic). The lowermost and

largest, at the surface of the right lobe, was diagnosed and
opened during life. From a native male, aged 30, who died in
hospital. (See further, prep. No. 303, Series IX, p. 342.)

62. Large abscess on the inferior surface of the right lobe of the liver
showing the passage of pus from the same into the inferior

702

APPENDIX A.

vena cava. There were multiple abscesses (pyaemic) in both
lungs.

63. Perihepatic abscess opening into the pericardium. Case of

Patrick O’Brien, aged 32, who died in hospital.

( See further, prep. No. 310, Series IX, p. 315, and Medical Post-mortem
Records, vol. I, 1875, pp. 769-70).

64. Scirrhus carcinoma of the liver. Case of Joseph Galestin

(Armenian), aged 80.

(For description, see prep. No. 336, Series IX, p. 319).

65. Scirrhus carcinoma of the liver. — The distorted and nodulated

condition of the organ on both its upper and under surfaces, and the
pinkish-yellow appearance of the infiltrating cancerous growths
are very characteristically displayed. From an East Indian
female, aged 40.

(See further, prep. No. 340, Series IX p. 351).

66. Enkephaloid carcinoma of the liver. — From a native female,

aged 60. The disease was of about four months’ duration.

( See prep. No. 334, Series IX, p. 349).

07. Enkephaloid carcinoma of the liver. — The appearances presented
by the morbid growths on the surface and on section of the organ
are very characteristically displayed. Case of a Hindu female,
aged 40.

(For description and history, see prep. No. 338, Series IX, p. 350).

68. 69. Two plates of melanotic (enkephaloid) carcinoma of the
liver. Both at the surface, and throughout the parenchyma,
the organ is thickly infiltrated with soft, dark, pigmentary
deposits, varying in size from a pea to a walnut. From an East
Indian male, aged 44.

(Sec further, prep. No. 342, Series IX, p. 352, and Medical Post-mortem
Records , vol. I, 1873, p. 16).

70. Enlarged, hypermmic and deeply bile-stained liver, from a fatal

case of acute cholsemia.

71. “Nutmeggy liver,” or chronic intra-lobular hepatic congestion

and pigmentation.

72. A section from the right lobe of a liver which weighed Slfes

11 ounces. It shows very extensive fatty infiltration, combined
with incipient cirrhosis, — the result of chronic alcoholism.

(See further, prep. No. 324, Series IX, p. 347).

73. Haemorrhagic infarctions (“blocks”) in the spleen, undergoing

decolourisation.

From a native female, aged 18, who died, on the ninth day after delivery,
from puerperal fever (septicaemia).

(Obstetric Post-mortem Records , vol. 1, 1875, p. 186).

74. A chronically enlarged and pigmented spleen, showing a large,

triangular-shaped decolourised infarction at its upper border,
and smaller scattered ones on the anterior surface, just beneath
the capsule.

From a native female, aged 18, who died from puerperal fever (septi-
caemia), on the ninth day after delivery.

75. Abscess of the spleen. — The organ is considerably enlarged,

and, at its upper end, close to the surface, a ragged abscess-

APPENDIX A.

703

cavity, the size of a small orange, may be seen, the walls of
which are sloughy, and were adherent to the diaphragm. From,
a native lad, aged 15.

(See prep. No. 35, Series X, p. 3G9).

76. Intense congestion of the kidneys in cholera, — death taking place

in the “ collapse stage.”

The congestion is seen to be chiefly venous, and is displayed principally
in the pyramidal structure, the cones of which present a dark
purplish (streaky) colour, from fullness of the straight veins.

77. Intense congestion of the kidneys, with desquamation of epi-

thelium, and obstruction of the uriniferous tubules (acute desqua-
mative nephritis) in cholera, — death taking place in the “ reaction
stage.” The congestion is most marked in the medullary
structure ; the cortex is comparatively pale, and has an opaque
yellowish appearance from intra-tubular shredding and accumu-
lation of epithelium.

78. Chronic passive congestion of the kidneys, with expansion of

the pelves and calyces, and commencing atrophy of the secreting
structure. From a case of puerperal eclampsia, — a native female,
(primipera), aged 19, who died, comatose, forty hours after
delivery.

(See further, prep. No. 24, Series XI, p. 3SS).

79. Intense dusky hypenemia of the kidne}Ts, with bile-staining.

F rom a fatal case of acute chokemia, — a native male patient who
died in hospital.

80. 81. Two coloured plates illustrative of a peculiar haemorrhagic

condition of the kidneys (nephritis purpurea), consisting of
great congestion with minute ecchymosis of the renal structure,
— the latter most marked at the surface. The drawings were
taken from well marked specimens, — in the one case, from a
native female, aged 28, who died of carcinoma of the rectum ;
in the other, from a native female, aged 20, who died of chronic
dysentery. In both instances there was no general purpuric
condition of the skin or mucous membranes, but excessive
ansemia or spansemia persisted during life, and was evidenced by
most of the organs after death.

82. Haemorrhagic infarction and acute suppuration of the kidneys.

Case of a European woman, aged 30, who died in hospital from
uraemia (convulsions, coma, &e.).

(For full description and history, see prep. No. 103, Series XI, p. 40Gt
and Medical Post-mortem Records , vol. Ill, 1879, pp. 167-G8).

83. Acute suppurative nephritis (“ surgical kidney”). The genito-

urinary organs of a native male patient, aged 45. The kidneys
are enlarged and highly vascular, thickly infiltrated with small
circumscribed abscesses. The prostate is swollen and pus-
infiltrated. There is a stricture at the junction of the mem-
branous and bulbous portions of the urethra, the prostatic portion
being dilated. ( See further, prep. No. 38, Series XII, p. 425
and Surgical Post-mortem Records , vol. I, 1877, p. 356)

84. Morbus Brightii. Large white kidneys (tubular nephritis).

704

APPENDIX A.

85. Cystic degeneration of the kidney, following or associated with

longstanding stricture of the urethra.

86. Cystic degeneration of the kidneys, most advanced in the left, the

cysts in which are of large size, and filled with opaque-white,
putty-like, phosphatic material. This condition was associated
with colloid cancer of the peritoneum.

87. “ Horse-shoe” kidney, showing the position and shape of the

organ, and its relations to the ureters and bladder.

88. 89. Two coloured plates, one showing an enormous elephantiasis

of the scrotum, the mass weighing, on removal, llOlbs., the
other, the appearance presented by the penis and perineeum after
the healing of the wound. The patient, a Hindu, aged about
40, was successfully operated upon by Professor S. B. Partridge.
[The diseased scrotum is now in the possession of the Royal
College of Surgeons, London.]

90. Elephantiasis scroti. — A very large growth, removed by operation,
but resulting in the death of the patient.

91. Elephantiasis of the scrotum and prepuce, a very large tumour,

successfully removed by operation.

92. Elephantiasis scroti. — Successfully removed by Professor

K. McLeod. The weight of the mass, after removal, was 48ibs.
Case of Ram Lai Bannerjee (Bengali), aged 48, admitted
31st October 3 875, discharged cured on 23st January 1S76.

93. Elephantiasis scroti. Weight 39Ibs. — Case of Ram Jeeban

Hazra (Bengali), aged 43, successfully operated upon by Professor
S. B. Partridge. Admitted 1st December 1873 ; discharged
10th January 1874.

94. Elephantiasis preputii. — A large softly tuberculated growth

affecting the prepuce only, — the scrotum remaining free of
disease.

95. Ncevoid elephantiasis of the scrotum, showing great dilatation

and varicosity of the superficial cutaneous lymphatics, associ-
ated with the thickening and oedema of the scrotal tissues.
Case of a young Hindu adult, operated upon successfully by
Professor K. McLeod.

96. Enkephaloid carcinoma of the uterus and appendages, with

consequent dilation of the ureters and pelves of the kidneys
(from pressure).

Case of a native woman, aged 40, who died in hospital.

( See further, prep. No. 53, Series XIV, p. 458.)

97. Enkephaloid carcinoma of the uterus. — Case of Elizabeth Lewis,

aged 40. — See prep. No. 56, Series XIV, p. 459, and Obstetrical
P ost-mortem Records , vol. I, 1877, pp. 353-54.

98. Colloid cancer affecting both ovaries, which are greatly enlarged,

vascular, and cystic. From a native woman, aged 40, who died
in hospital. (For description and history, see prep. No. 205,
Series XVII, p. 587, and Medical Post-mortem Records, vol. I,
1875, pp. 807-8.)

99. Dropsy of the Fallopian tubes. — Their fimbriated extremities pre-

sent a convoluted, highly distended, and swollen condition, and
contained clear, limpid, serous fluid. Found on post mortem

APPENDIX A.

705

examination of the body of a native female, aged 25, who died
from pulmonary phthisis. No symptoms ol the tubal disease
existed during life. (Prep. No. 99, Series XIV.)

100. Very far advanced tubercular leprosy. The characteristic

thickening of the skin of the face (nose, ears, &c.), and or the
nipples is well seen, and also the peculiar contraction ol the
fingers. Case of J. It. — (Eurasian), aged 26. .

101. Elephantiasis Groeeorum, or true leprosy (mixed variety). I lie
tuberculated condition of the face, and amesthetic stainings of
the body generally, are well seen. The patient was a young man
of mixed parentage, under treatment in hospital. .

102. Elephantiasis Grsecorum (leprosy) — mixed variety, a Hindu
male, aged 45. The serpiginous character ol the eruption is
well displayed.

103- Elephantiasis Grsecorum (leprosy), mixed variety.— The leprous
eruption in a state of ulceration. Case ol a native (Hindu)
lad, aged 18, who underwent treatment by gurjan oil, but with
no benefit.

104. Morphcea alba.

105. Molluscum fibrosum (fibroma fungoides.)

106. Molluscum fibrosum.— Sketch of a native woman, aged 22, the
body covered with semi-pendulous fibroid growths, varying in
size" from a hazelnut to an orange. A very large mass of the
same structure is attached, by a broad fleshy peduncle, to the
inner side of the left arm. The growths were said to be con-
genital. One, removed from the left gluteal region, was examined
microscopically, — see prep No. 73, Series XVI, p. 505.

107. Molluscum fibrosum.— A very large lobulated, semi-pendulous,
and darkly pigmented growth, involving the skin and subcutane-
ous tissues of the buttocks, lower part of the back, and left
thigh of a young Hindu lad. A portion of the mass was excised,
and is described in prep. No. 72, Series XVI, p. 504.

108. Tubercular syphiloid affecting the face principally. Case of a
European patient in hospital.

109- Syphilitic alopecia.

110. 111. 112. Mycetoma — the so-called “ fungus-foot.” Case of

Lai' Mohun, aged 40, a native of Burdwan (Bengal). The
growth was of eleven years’ duration. Admitted into hospital
17th January 1877 ; amputation of the foot performed 30th
January; discharged cured, 15th April 1877. The appear-
ances presented by the foot (right) are characteristic, and the
larger drawings (111 and 112) display, very distinctly, the
morbid changes in the skin, and (as revealed on longitudinal
section) in the soft parts and osseous structures.

113. “ Aihnum.”— Appearances presented by the amputated toe in
this disease, — see prep. No. 47, Series XVI, p. 499.

114. A round-celled sarcoma involving the bony and soft tissues on
the anterior aspect of the lower third of the right forearm. From
a native male patient, aged 50.

(Prep. No. £>, Series XVII, p. 524).

706

APPENDIX A.

115. Spindle-celled sarcoma of the left thigh, of five months’ growth.
From a Mahomedan boy, aged 9 years. Amputation performed
at the hip-joint. (Prep. No. 37, Series XVII, p. 531).

116. Spindle-celled sarcoma of the right leg, involving only the tibia.
Case of a native male (Hindu), aged 25.

(Prep. No. 39, Series XVII, p. 535).

117. Spindle-celled sarcoma of the left femur, of about nine months
growth. From a native lad, aged 10. Amputation performed at
the hip-joint.

118. Osteo-sarcoma of the right leg. The growth involves the upper
two-thirds of the tibia, and superjacent soft parts. The knee-
joint was not affected. From a native male patient, aged 18.
Disease of about nine months’ duration.

(Prep. No. 134, Series XVII, p. 508).

119. Polypoid or pendulous fibroma of the right shoulder, — a growth
of about two and a half years. Successfully removed by oper-
ation. Case of a native male in-patient, aged 48

120. Fibroid epulis of the upper jaw, — successfully removed by oper-
ation.

121. 122. 123. Fibroma of the lower jaw. Three plates showing,
respectively, (a) the appearance of the patient prior to operation,
(b) the result of the operation, and (c) the structure of the
growth after removal.

Case of Bhipro, a Hindu, aged 20. Disease of three years’ duration.
(Prep. No. 74, Series XVII, p, 547).

124. 125. Fibro-cystic tumour of the lower jaw, of about three and
a half years’ duration. Two plates, — one showing the appearance
of the patient prior to operation, the other, the structure of the
growth after removal with the jaw. Case of a Hindu, aged 40.
(See further, prep. No. 80, Series XVII, p. 549).

126. Enormous fatty tumour (fibro-lipoma) of the back and neck,—
said to be of about three years’ growth. The patient was a
Mahomedan, aged 40.

( See further, prep. No. 98, Series XVII, p. 555).

127. 128. F ibroid enchondroma, of twenty years’ growth, in a
native female, aged 60, — successfully removed by Professor
Gayer. The two plates show, respectively, the appearance of the
patient prior to removal of the tumour, and of the latter, after
removal.

(See further, prep. No. 113, Series XVII, p. 559).

129. 130. 131. Three sepia drawings of a gigantic ossifying enchon-
droma of the left leg. The first exhibits the entire growth with
the amputated leg. The second and third show the appearances
presented on vertical section through the tumour.

(Prep. No. 108, Series XVII, p. 557).

132- Enchondro-sarcoma of the upper end of the right femur,
forming a huge lobulated mass, which measured 2G'' "in circum-
ference.

Case of a native male patient, aged 60, who died in hospital. The
tumour was of about two years’ growth.

(Prep. No. 12 1, Series XVII, p. 562).

APPENDIX A.

707

133. 134 Osteoma of the right tibia, of about eight years’ duration.
Two plates showing, respectively, the appearance of the limb prior
to amputation, and the cavernous structure of the tumour on
longitudinal section of the parts involved. From a native male,
aged 35. (Prep. No. 125, Series XVII, p. 5G1).

135 An excellent representation of the structural anatomy of chronic
mammary glandular tumour (acinous adenoma).

136. Enkephaloid carcinoma of the femur, for which amputation at the
hip-joint was performed, but the growth recurring in the stump
and pelvis, the patient, a native lad, aged fifteen, died about
three months after the operation.

137- Enkephaloid carcinoma of the lower end of the right femur,
involving the knee-joint. A growth of five months’ duration ;
from a Hindu lad, aged 15. Amputation performed at the
hip-joint.

{See further, prep. No. 203, Series XVII, p. 586).

138- A sepia-drawing of an hermaphrodite foetus born in the hospital.

139. Female foetus with aborted twin- development. For full descrip-
tion, see prep. No. 22, Series XVIII, p. 620.

140 Congenital malformation of the index and middle fingers of the
right hand. Case of a native male, aged 30, who died from
psoas abscess, &c.

( See prep. No 17, Series XVIII, p. 620).

, iv

APPENDIX B.*

CONTINUATION TO SEMES I.

FRACTURES AND DISLOCATIONS.

INDEX.

Fracture of the spine, 198.

,, ,, PELVIS, 199.

,, ,, FEMUE, 200.

Gunshot feactures, 201, 202.

Illustrations of trephining, 203, 204.

198. Fracture of the last dorsal vertebra, the result of the fall of a
bag of rice upon the back of a native coolie. The vertebra has
been completely crushed, the body being extensively comminuted.
A linear fracture also, running perpendicularly, has produced
wide Assuring of the posterior half of the body of the eleventh
dorsal, and extends into the lower half of the posterior lamina
of the tenth dorsal vertebra. There was considerable laceration
of the cord. The patient was admitted into hospital quite
paraplegic, and died on the eleventh day after the injury.

199. Comminuted fracture of the pelvis, involving the rami of the
pubes and ischium, and the lateral masses of the sacrum.

200. Compound comminuted fracture of the lower third of the left
femur, with erosion of the femoral artery by the sharp edge of
the broken bone, causing secondary haemorrhage, and necessitat-
ing amputation of the thigh.

Case of a native male, aged 50, who fell from a tree, and was admitted
with a compound fracture of the thigh, on the 28th November
1880.

The wound was dressed antiseptically, and the fracture reduced. On
the 31st December, secondary haemorrhage, in the form of smart
oozing from the wound, set in, and continued intermittingly, in
spite of all attempts to control it, for four days, when amputa-
tion had to be performed.

The preparation is interesting as showing the amount of repair
accomplished in so severe an injury. The medullary canal,
above and below the fracture, is closed by firm organising

* Preparations added to the museum (or overlooked) during the passage through the
press of the several parts of this Catalogue.

APPENDIX B.

709

exudation (lymph), and a large detached fragment still retains
its vitality, although only partially invested by periosteum.
The cause of the secondary haemorrhage was an injury to the
external coat of the femoral (in Hunter’s canal), probably
at the time of the accident, — the walls of the vessel, at this
spot, becoming gradually thinned, and at last, i.e., after the
lapse of more than a month, giving way. A very minute
opening, not larger than a pin’s head, was found, deeply seated,
on the inner side of the lower fragment, and the recurrent and
severe haemorrhage was evidently from this part of the artery
The femoral vein is quite healthy. Two glass rods indicate,
respectively, the positions of these vessels, and that in the artery
has been pushed through the walls at the spot where injured, as
above described.

Presented by Professor K. McLeod.

201. Compound fracture of the shaft of the humerus, close to the sur-
gical neck, the result of gun-shot injury. “ The gun, loaded with
shot, was within a couple of feet of the shoulder when it exploded.”
The aperture of entrance is rounded, and its margins are blackened
by gunpowder. The upper fragment is denuded of periosteum (by
the spread of the charge), and the lower is splintered for some
distance.

Case of J. (x — , an Eurasian lad. The limb was amputated at the
shoulder-joint.

Presented by Professor S. B. Partridge.

202. A preparation showing a gun-shot injury to the right hand. The
charge apparently entered the palm of the hand, in the interspace
between the index finger and thumb, and made its exit at the
corresponding portion of the dorsum, the orifice here being large
and much lacerated. The second and third metacarpal bones and
several of the bones of the carpus are comminuted. The
thumb has been almost completely blown off.

203. The vertex of the skull, with a circle of bone removed by the
trephine.

“ The man was thrown from a horse, fell on his head, was picked up in-
sensible, symptoms of pressure supervened, the trephine was applied
and the circle of bone removed without finding blood or affording
relief. He died from bleeding into the corpus striatum.”

The skull-cap is remarkably thin, but, curiously enough, is not fractured,
although the force of the fall was sufficiently severe to produce
laceration of and hannorrhage into the brain-substance.

The aperture made by the trephine is situated half an inch above and
behind the anterior inferior angle of the right parietal bone,
between the grooves for the anterior and posterior branches of
the middle meningeal artery, neither of which are implicated.

Presented by Professor W. J. Palmer.

204. Portions of trephined bone from the skull, being fragments of
a depressed fracture of the right parietal bone. Prom a native
male, aged 32, employed at the Ishapore Gunpowder Factory.
The man “ was working in the mill-yard, when an explosion took
place in a house which stood about 250 yards from where he was.

710

APPENDIX B.

“ At the moment of the explosion he was in the act of stooping
down, repairing the tramway line. He felt a sudden shock, and
was thrown down, but heard no noise, and believes that his head
came in violent contact with the iron rail. Insensibility ensued,
but he quite recovered consciousness by the time he was removed
to the hospital, — a period of about a quarter of an hour. Five
hours afterwards, there being still no symptoms, the skull was
trepanned. The patient remained in hospital for one month and
eleven days, suffering hardly any inconvenience. When discharged,
he at once resumed his work.”

( See further, Indian Medical Gazette , December 1874, p. 317).

Presented by Surgeon-Major E. A. Birch, f.r.c.s.

CONTINUATION TO SERIES II.

DISEASES OF THE BONES.

INDEX.

Periostitis (syphilitic node), 192.

Necrosis, 193, 194, 195.

Tumour, 196, 197.

192. Syphilitic node of the tibia, the result of chronic specific peri-
ostitis and ostitis. The bone over the skin, fora space of 3" in
length and 1" in breadth is rough, raised, and forms an oval-
shaped bony excrescence, which, on section, is seen to consist of
a dense thickening of the compact tissue of the shaft, extending
also into the medullary canal, and producing great narrowing
of the same, with consolidation of the cancellous structure.

From a West Indian adult (male), who died of “syphilitic phthisis.”

Presented by Dr. A. Vans Best, Presidency General Hospital.

193. “Sequestrum from a case of cancrum oris, consisting of the
palatine plate and part of the alveolar process of the right
superior maxillary hone, the palatine and perpendicular plate and
pterygoid process of the right palate bone, and part of the right
pterygoid process of the sphenoid. 1 he posterior or palatine
canal is included in the sequestrum.” (Colles).

Presented by Professor N. Chevers.

194. “ Anterior portion of both superior maxillary bones (with the
right canine tooth still in situ), exfoliated from a case of can-
crum oris in a native lad. The patient died of pneumonia of
a low type. He had been exposed to malaria. ’ (Colies.)

Presented by Professor N. Chevers.

195. Exfoliated portions of the shaft, from a case of necrosis of the
radius. No history.

Presented by Surgeon-Major E. A. Birch, Hazaribagh.

APPENDIX B.

711

196. The bony framework or skeleton of a large tumour (osteo-
sarcoma) involving the middle third of the right tibia. The fibula
is deflected outwards considerably, but not involved in the
growth. “ From a native. Amputation was successfully per-
formed below the knee.”

Presented by Dr. T. Duka, Civil Surgeon, Monghyr.

197. A similar specimen. The bony portion of a large growth (osteo-
sarcomatous tumour) involving the whole of the inferior extremity
and lower third of the shaft of the left tibia. The morbid
growth probably originated in the cancellous tissue or medullary
canal, and has expanded the bony structures around it. Its
dimensions are — circumference transversely 15," longitudinally
20." No history.

CONTINUATION TO SERIES III.

DISEASES OF THE JOINTS.

INDEX.

Resection of joints foe caeies, 57, 58.

57 Caries of the head of the humerus. The cancellous tissue is
much softened, and at one part deeply excavated. The bone
was removed after opening the shoulder-joint (resection.)

Presented by Professor J. Fayrer.

58- Excision of the knee-joint for chronic articular disease. A section
from the condyles of the femur, another from the head of the
tibia, and the whole of the patella, were removed, and are
preserved. The articular cartilage is seen to have undergone
almost complete absorption ; the bone is exposed and carious,
considerably excavated on the inferior aspect of the internal
condyle. The joint, when opened, was found full of pus. Case
of a native male patient (Hindu), aged 30.

Presented by Professor D. O’C. Raye.

CONTINUATION TO SERIES V.

DISEASES OF THE SPINE.

INDEX.

FlBEOID DEGENEBATION OF VEBTEBB.E, 24.

24- A portion of the dorsal and lumbar spine of a native male (Hindu),
aged 40, who died paraplegic, after the removal of a sarcomatous

712

APPENDIX B.

tumour from the back. ( See prep. No. 53, Series XVII, p. 541.)
A recurrent sarcomatous nodule had made its way into the spine,
the eleventh dorsal vertebra (see preparation) being almost
entirely absorbed, and the cord and membranes much softened
and compressed at this spot. The upper half of the twelfth
dorsal vertebra is seen converted into firm, but lardaceous
looking material, having a glistening pale-yellowish appearance.
The first lumbar vertebra is healthy, the second completely
transformed into the same substance as above noted. The third
lumbar is again free, but the fourth and fifth degenerated. The
changes referred to are very peculiar. No reproduction of specific,
i.e., sarcomatous structure, is discoverable on microscopic examin-
ation, except in the soft parts in the immediate vicinity of the
destroyed vertebra (eleventh dorsal). The glistening lardaceous
material into which the bodies of the other vertebrae have been
converted is purely fibroid , i.e., consists of closely-meshed white
fibrous tissue, firm and tough, swelling up on the addition of
acetic acid, and then displaying numerous small nuclei, but no
proper cell elements, and nothing approaching to sarcomatous
transformation. The change seems to consist, essentially, of a
dissolving out of the mineral or earthy matter of the bone,
and its consequent reversion to a primative fibroid tissue, either
wholly or in part.

CONTINUATION TO SERIES VI.

INJURIES AND DISEASES OF THE HEART
AND BLOOD-VESSELS.

INDEX.

Rupture of the heart, 345.

Partial or local dilatation (aneurtsmal pouching), 346.

Thickening and induration of valve-flaps (syphilitic), 347.

Aneurism of arch of aorta (ascending portion), 348.

Effects of the treatment of aneurism (laminated fibrinous
deposit), 349.

345. Rupture of the heart. — The preparation exhibits two lacerations
involving the entire thickness of the cardiac walls. Both are
situated on the posterior surface of the left ventricle. One, \ f
long, commences at the base of the left appendix auriculae, and
extends in a direction downwards and backwards. The other,
about 4" in length, and running at first along the left auriculo-
ventricular groove, reaches the posterior inter- ventricular furrow
through which it extends as far as the apex of the heart, laying
open the left ventricle completely, but leaving the septum intact
and also the right cavities.

APPENDIX B.

713

The margins of both lacerations are irregular and ragged.

“ The man was a healthy railway employe, aged 30 ; was jammed between a carriago
which was being shunted and a gate. He died almost immediately. Besides
the injury to the heart, the liver was slightly fissured in two places, on the
upper aspect of the right lobe posteriorly. The pericardium was filled with
coagulated blood. There was no sign of an external bruise, and no bones
were broken, ribs all uninjured. The heart was crushed between the sternum
and the spine. There was an eccbymosed patch ou the front of the spine
behind the heart.” (Note by Dr. O’Brien.)

Presented by Dr. J. O’Brien, Civil Surgeon, Burdwan.

346. A preparation showing a greatly dilated and hypertrophied heart,
with extensive chronic inflammation of the lining membrane
and valves (endocarditis), and aneurismal pouching of the left
ventricle.

In the right ventricle the endocardial thickening is very remarkable,
especially towards the apex and over the anterior wall, where the
muscular tissue has almost entirely disappeared. The pulmonary
valves are healthy. The superior and inferior tricuspid valves
are thinned and stretched, the posterior flap is adherent to the
posterior ventricular wall, and blended with the fibroid thicken-
ing of this part. The right auricle and ventricle are both
greatly dilated.

On the left side, there is similar very marked endocardial thickening,
affecting both auricle and ventricle, with dilatation of these
cavities, and slight opacity of the mitral and aortic valves,
particularly of the latter. The changes are, however, less valv-
ular than general, i.e., affect principally the endocardial
lining of the ventricle. At the superior and posterior angle of
the latter — the retiring angle between the posterior wall and
reptum — and about half an inch below the aortic orifice, there
is an aneurismal-like dilatation of the ventricular wall, suffi-
cently large to hold a hen’s egg. It projects backwards and to
the right. The muscular tissue forming this pouch is much
thinned where it reaches the surface of the heart. Its inner
surface is lined by thickened vascular endocardium, and it con-
tained dark, soft, blood-coagulum, — no laminated fibrin.

There was general, acute, sero-fibrinous pericarditis of recent origin ;
and no less than thirty ounces of dark, sanguinolent, turbid
fluid filled the pericardial sac. The heart weighs 19 ounces. From
a native male patient, aged 40, who died in hospital.

347. The heart of a native male (Hindu), aged 42, who was under
treatment in hospital for syphilitic necrosis of the palate and
nasal bones, but who died of dysentery. The aortic valves
exhibit remarkable thickening, puckering and distortion. Their
structure, at the free margins, is almost cartilaginous in con-
sistency, yet quite free from calcareous deposit, so common in
ordinary atheroma. The changes are, therefore, believed to be
specific, i.e. syphilitic in character.

( See further, Surgical Post-mortem Records, vol. I, 1881, pp. 869-70).

348. Large sacculated aneurism of the thoracic aorta. It is the
size of a pomegranate, ovoid in shape, and arises from the angle

714

APPENDIX B.

of junction of the ascending and transverse portions of the arch.
The mouth of the sac is situated about two inches above the
aortic orifice, it is rounded, and has a diameter of two and a half
inches. The margin is prominent, but smooth. All the coats
of the vessel apparently enter into the formation of the sac.
Its inner surface is thickened and opaque, and its cavity about
three parts filled with laminated firm decolourised coagulum,
while a large, partially fibrinous, and more recent clot was found,
post mortem , extending into the mouth of the sac from the left
ventricle. The orifices of origin of the innominate, left carotid,
and left subclavian arteries are not involved in the aneurism.
The latter extends backwards and to the right. The anterior
and outer surfaces of the sac are thickened by adventitious
fibrous tissue, the posterior wall is greatly thinned, and was
closely adherent to the trachea (for about two inches above its
bifurcation), and also to the right and left bronchi.

The inner surface of the whole of the aortic arch shows patches of
atheromatous thickening, and is generally opaque and rigid.
The innominate artery, for the whole of its extent, is bound
down, by strong fibrous adhesions, to the upper and outer aspects
of the aneurismal tumour.

History. — “ Charles F — , an English seaman, aged 41, was admitted into the
Presidency General Hospital on the 18th March 1880. He stated that
he had had an asthmatic attack five or six months ago. Three weeks ago
began to cough and suffer from difficulty of breathing, and now cannot
lie down.”

“ There is considerable dyspnoea ; a loud, shrill, tearing cough. Pulse weak. Skin
pale and moist from copious perspiration. Physical examination of the
chest showed nothing more than loud bronchitic, wheezing and sonorous
rftles everywhere, with some moist sounds. The heart’s sounds were faintly
audible, but normal, presenting no murmur.”

“ The man got steadily worse each day. He could get no sleep, and in addition
to the peculiar cough, his respiration became very harsh and loud. His
voice remained clear, and it was very evident that the larynx was not at
fault. He died exhausted on the 27th March 1880.”

Presented by Dr. C. H. Joubert, Presidency General Hospital.

349. “ Finely laminated coagulum of fibrine from a spontaneously

cured case of aortic aneurism.” (Ewart.)

Presented by Dr. Edward Goodeve.

CONTINUATION TO SERIES VII.

INJURIES AND DISEASES OF THE LARYNX,
TRACHEA, BRONCHI, AND BRONCHIAL
GLANDS, OF THE LUNGS AND PLEURA.

INDEX.

Morbid growth: from efiglottis, 158.
Ulceration of the larynx (syphilitic), 159.

APPENDIX B.

715

Phthisis (tubercular), 160.

,, (nON-TUBERCULAB OB CATABRHAL, WITH PYO-THOBAX), 161.

Tracheotomy, 162.

158. The larynx of a Hindu male, aged 50, who died from chronic
dysentery, showing a small polypoid growth developing from
the anterior aspect of the right half of the epiglottis. It is
the size of a small hazelnut, and lies in the sulcus between the
base of the tongue and epiglottis. On incision is found to be
a sebaceous cyst, — is filled with thick creamy pinkish-white
material. No difficulty in respiration or deglutition seems to
have been occasioned by the presence of this growth, which was
only discovered post mortem.

159. Syphilitic laryngitis. The larynx of a native female, aged 35,
who died in hospital. At the base of the tongue, between it
and the epiglottis, the mucous membrane presents an opaque,
thickened, and puckered appearance. The epiglottis itself is
deeply fissured. The mucous membrane on its under surface is
swollen and granular, had a dusky-red or purplish colour in the
fresh state. The aryteno-epiglottidean folds are extensively
uleerated, and there is also a deep ulcer at the junction of the
vocal cords anteriorly. The superior vocal cords have been
entirely destroyed, and also the left true vocal cord. The mucous
and submucous tissues investing the arytenoid cartilages are
greatly swollen and oedematous, and the rima glottidis so greatly
contracted, that it admits with some difficulty a crow-quill.
The cricoid cartilage, for its posterior half, is exposed, rough,
and denuded of perichondrium (necrosed).

(Surgical Post-mortem Records, vol. I, 1881, pp. 789-90.)

160. The left lung of a native male patient (Hindu), aged 20, who
died in hospital, showing, very typically, the morbid anatomy
of acute tubercular phthisis. The immediate cause of death
was tubercular meningitis (cerebral), with softening of the
posterior superficial laminae of the left optic thalamus, and
adjacent portion of the posterior cerebral lobe. There was
much lymph effused at the base of the brain, and the ventricles
were distended with turbid serum.

161. Broncho-pneumonic or caseous phthisis, associated with pyo-
thorax. The left lung of a native male, aged 21, exhibiting
considerable cheesy consolidation, and riddled with larger and
smaller cavities or vomicae, one of which, at the upper and
back part of the lower lobe, burst into the pleura, and set up
acute suppurative inflammation (empyema), to which the patient
rapidly succumbed.

( See further, Medical Post-mortem Records, vol. Ill, 1881, pp. 811-12).

162. The larynx and a portion of the trachea of a native male patient,
aged 32, who died from pulmonary phthisis, but on whom the
operation of tracheotomy had been perlormed in this hospital
(by Professor Partridge) two and a half years previously, for
the relief of laryngitis — probably tubercular.

716

APPENDIX B.

The opening into the windpipe had not been allowed to heal, and the
skin has cicatrised around it, so as to keep it permanently patent.
In the interior of the larynx, the mucous membrane on the
under surface of the epiglottis is thinned, but not ulcerated. The
lower (true) vocal cords are yellowish, fibrous, wasted-looking.
The aryteno-epiglottidean folds are a little oedematous.
{Surgical Post-mortem Records, vol. I, 1879, pp. 687-88.)

CONTINUATION TO SERIES IX.

INJURIES AND DISEASES OF THE TONGUE,
TONSILS, PHARYNX, OESOPHAGUS,
STOMACH, INTESTINES, PERITONEUM,
LIVER, AND PANCREAS, &c.

INDEX.

Cirrhosis of the liver, and perihepatic abscess, 382.

382. A highly cirrhotic (hob-nail) liver, weighing 41| ounces. The
upper surface of the left lobe, for a space of about the size of the
palm of the hand, is seen superficially ulcerated, shreddy, and
undergoing disorganisation. At this spot an abscess had formed
between the liver and diaphragm (perihepatic), and, perforating
the latter, opened into the base of the left lung, and was iu
process of evacuation through the bronchi. The patient, a
Hindu male, aged 27, was brought into hospital in a moribund
condition, — passing copious melsenic stools, and died 19 hours
after admission.

{See further, Medical Post-mortem Records, vol. IY, 1881, pp. 39-40).

CONTINUATION TO SERIES X.

INJURIES AND DISEASES OF THE SPLEEN, &c.

INDEX.

Thickening of capsule, 104.

Amyloid or albuminoid infiltration, 105.

104. Enormous thickening of the capsule of the spleen. Over the
upper half of the convex (outer) surface of the organ it is as
hard as bone, from i" to in thickness, and completely calci-
fied. The splenic substance is soft, dull reddish-brown in colour;
the trabecular structure throughout hypertrophied.

From a native male, aged 50, who died in hospital of chronic dysentery.
{Medical Post-mortem Records, vol. Ill, 1881, pp. 827-28.)

APPENDIX B.

717

105. Amyloid infiltration of the spleen. The organ is a little
enlarged, — weighing 8| ozs.. The capsule is thickened and
opaque in patches. The splenic substance is firm, has a reddish-
brown colour, the Malpighian bodies are hypertrophied, promi-
nent, semi-transparent, and glistening. The characteristic reac-
tion with iodine-solution is given.

From a native male patient, aged 40, who died of chronic catarrhal
phthisis. ( Medical Post-mortem Records , vol. II, 1878, p. 700.)

CONTINUATION TO SERIES XII.

INJURIES AND DISEASES OF THE BLADDER
URETHRA AND PROSTATE GLAND.

INDEX.

Rupture of the bladder, 57.

57. “Rupture of the bladder at the fundus. The rent is about an inch
and a half in length. The peritoneum is opaque and greatly
thickened.” (Ewart). No history.

Presented by Professor S. B. Partridge.

CONTINUATION TO SERIES XVI.

DISEASES OF THE ORGANS OF SPECIAL
SENSE, AND OF THE SKIN.

INDEX.

Keloid growth from the skin, 97.

97. A keloid growth, of two years’ duration, removed from the right
deltoid region of a native male (Bengali), aged 18. It originated
in the cicatrix left in the skin after the healing of a ringworm
{tinea circinatd) by the application of caustic lime mixed with
clay-. The structure is throughout fibroid, firm, glistening;
consists of white fibrous tissue intermingled with a few elastic
filaments.

Presented by Professor H. C. Cutcliffe.

C T

V/j-

...GENERAL INDEX.

Abdominal wall and viscera, tumours of,
XViri. 30. p. 532; 73, p. 547; 89,
p. 554 ; 150, 153, 154, 155, p. 573 ; 1S2,
p. 580 ; 204, p. 587 ; 228, 229, p. 594 ;
250, p. 600 ; 259, p. 602 ; 294, p. 608.

Abscess and fistula in perinseo — see urethra.

Abscess of bones, chronic — see bones.

Abscesses communicating with joints — see
joints.

Absorption of cartilage— see cartilage.

Aneneephalous monstrosities — see monstrosi-
ties.

Acute necrosis — see necrosis.

Aihnum, XVI. 47, 48, p. 499. Drawing
No. 113.

Amphistoma hominis — see ontozoa.

Amputation, injuries necessitating, I. 69,
71, p. 21 ; 75, 76, 77, 79, 80, p. 22 ; 82,
83, p. 23 ; 90, p. 24 ; 93, p. 25 ; 135,
p. 31 ; 136, p. 32 ; 138, 139, 141, p. 33 ;
150, p. 34 ; 151, 152, 153, 155, p. 35 ;
156, 157, 158, p. 36; 160, 161, 162,
p. 37 ; 167, 168, 172, p. 38 ; 175, 179,
ISO, p. 39 ; 181, 182, 184, p. 40 ; 188,
p. 41.

Amputation, stumps after, II. 150, p. 74;
182, p. 77. Casts Nos. 2, 3.

Amputations — see also bones, caries, joints,
necrosis, osteo-myelitis, tumours.

Aneurism— see arteries.

Aneurismal pouching of walls of heart-
see heart.

Aneurism of valve-flaps — see heart.

Angular curvature of spine — see spine.

Angular displacement of fractures— see frac-
tures.

Amyloid degeneration — see liver, spleen,
kidney.

Animals, hypertrophy of bone in, II. 191,
p. 79.

Animals, necrosis of bone in, II. 192, p. 79.

Animals, repair of fracture in, I. 191, 192,
193, 194, 195, p. 41.

Animals, tumours and morbid growths in,
XVII. 298, 299, p. 610; 300, p. 611.
VIII. 91, 92, p. 267.

Animals, preparations illustrating malform-
ations and diseases of the ovum, &c.,
XVIII. 73 to 97 inclusive, pp. 627-28.

Ankle, dislocation of, I. 151, p. 35 ; 185,
186, 187, p. 40 ; 188, p. 41.

Ankle, fractures into — see joints.

Ankle-joint, diseases of — see joints.

Ankylosis — see joints, spine.

Ankylosis after union of fracture, I. 144,
145, p. 34 ; 154, p. 35.

Anthrax — see carbuncle.

Antrum of Highmore, tumours, &c. , of, II.
45, p. 54. XVII. 118, p. 561 ; 202, p.
586.

Anus, artificial — see artificial anus.

Anus, imperforate — sec intestines (malform-
ations).

Aorta — see arteries.

Aortic valves— see heart.

Apoplexy, pulmonary — see lungs.

Arm, tumours of, XVII. 7, p. 524 ; 12, p.
526 ; 13. p. 527 ; 26, p. 531 ; 31, p. 532 ;
77, p. 548 ; 253, p. 601.

Arsenic poisoning, effects of — see stomach.

Arteries, general affections of : —
atheroma, with or without calcareous in-
filtration, VI. 206 to 232 inclusive,
pp. 159-165. Drawing No. 26.
general dilatation, VI. 207, 210, 211, p.
160 ; 214, 220, p. 161 ; 223, p. 162 ; 234,
p. 165 ; 246, p. 170 ; 257, p. 175 ; 259,
260, p. 176 ; 262, p. 177 ;296, p. 191.
partial dilation or aneurism, VI. 235 to
307 inclusive, pp. 165-197- Appendix
VI. 348, p. 713. Casts, Nos. 5, 6, 7.
Drawings, Nos. 27, 28, 29.
aneurism by anastomosis, XVII. 258,
259, p. 602.

rupture from external violence, VI. 190
to 198 inclusive, pp. 155-57.
results of ligature of, VI. 199 to 202 in-
clusive, pp. 157-58.

thrombosis, VI. 203, 204, p. 159; 208,
p. 160 ; 233, p. 165.
ulceration, VI. 205, p. 159.
irregularity in the origin and distribution
of, VI. 205, p. 159 ; 214, p. 161 ; 255,

p. 174; 259, p. 176 ; 270, p. 179 ; 277,

p. 183 ; 282, p. 185 ; 294, p. 190 ; 303,

p. 196 ; 308 to 324 inclusive, pp. 198-

200.

Arteries, individual, affections of : —

aorta, thoracic, VI. 206 to 218 inclusive,
pp. 159-61 ; 235 to 285 inclusive, pp.
165-187; 170, p. 253; 296, p. 191.
Casts Nos. 5, 6, 7. Appendix, VI. 348,
p. 713.

aorta, abdominal, VI. 208, 21j0, 213,
p. 160 ; 219 to 224 inclusive, pp. 161-62;
286 to 295 « inclusive, pp. 187-191.
Drawings Nos. 27, 28, 29.
innominate artery, VI. 252, p. 172 ; 259,
p. 176 ; 265, p. 178; 267, p. 179 ; 296,
297, p. 191 ; 298. p, 192.
common carotid, VI. 299 to 301 inclusive,
pp. 192-94.

subclavian, VI. 302, 303, pp. 195-96.
external iliac, VI. 303, 304, p. 1 96.
popliteal, VI. 306, 307, pp. 196-97.
pulmonary artery, VI. 225, 226, p. 163.
mesenteric artery, VI. 232, p. 165.
arteries of upper extremity, VI. 227,
228, p. 164.

lower extremity, VI. 229, 230,

231, pp. 164-65.

cerebral arteries, VIII. 47, p. 256 ; 68 to
87 inclusive, pp. 261-06. Drawing
No. 40.

Arthritis, rheumatic— see joints.

720

GENERAL INDEX.

Articular surfaces of bone, caries and
necrosis of— .see caries and necrosis.

Artificial anus, IX. 195, 196, pp. 323-24 ;
205, 206, p. 326.

Atheroma of arteries — see arteries.

Atrophy of bone — see bones.

Auricles of heart — see heart.

Axilla, tumours of, XVII. 139, p. 569 ; 145,
p. 571 ; 151, p. 573.

Back, tumours of, XVII. 10, p. 525 ; 50, 51,
52, 53, pp. 540-41 ; 98, p. 555 ; 219,
p. 591. Drawing No. 126.

Base of skull, fracture of — see skull.

Bile-ducts, dilatation of, IX. 369, 370,

p. 357.

obstruction of, IX. 359, 360, 361,

pp. 355-56.

occupied by round worms, IX. 362, 363,
p. 356.

Biliary calculi, XX. 263 to 273 inclusive,
pp. 676-78.

Bladder, rupture of, XII. 1, 2, p. 416.
Appendix XII. 57, p. 717.

— — , in fracture of pelvis,

I. 100, p. 26.

inflammation of (acute), XII. 10, 11,
p. 417 ; 34, p. 423.

— (chronic), XII. 12, 13,

p. 418 ; 16, p. 419 ; 22, p. 420 ; 50,
p. 428.

hypertrophy of, XII. 3 to 8 inclusive,

pp. 416-

17;

12, 13

, 14,

P-

418;

16,

p. 419;

24,

p. 421

; 35,

P-

424;

39,

p. 425 ; 40, p.

426 ; 45, p.

427.

ulceration

of,

XII.

10,

P-

417;

15,

p. 419 ; 51, p.

428.

sacculation

of.

XII.

16,

419;

31,

p. 422.

fistulse of,

XII. 17,

18,

19,

20,

pp.

419-20.

calculi of,

XII. 21,

22,

P-

420;

30,

p, 422. XX. 1 to 250 inclusive, pp.
645-74. (For chemical composition of
these calculi, see index to that series
pp. 643-441.

effects of lithotomy, XII. 23 to 28 in-
clusive, pp. 421-22 ; 53, p. 430.

— ■ lithotrity, XII. 29, 30, 31,

p. 422.

Bladder (female), slough of, XII. 55, p. 430.

— , laceration in operation of

ovariotomy, XII. 56, p. 430.

Bones, fractures of — see fractures, and the
names of the individual bones ; also
carpus, tarsus, skull, &c.
gunshot and other wounds of, I. 24,
p. 10: 31, 32, p. 12; 58,59, 60, p. 19;
67, p. 20 ; 82, p. 23 ; 97, 98, p. 25 ;
105, p. 27; 139, 140, 141, 142, pp.
33-34 ; 162, p. 37. Appendix I. 201,
202, p. 709.

general affections of ; —

atrophy, II. 8, p. 48; 141, p. 72.
hypertrophy, II. 1 to 7 inclusive, pp.

47-48 ; 65, 66, p. 58.
fatty degeneration, II. 96, p. 63 ; 183,
184, pp. 77-78.

Bones — continued.

inflammation or ostitis, II. 65, 66, 67, p. 58 ;
107 to 117 inclusive, pp. 65-67 ; 125,
p. 69 ; 145 to 149 inclusive, p. 73 ; 160,
p. 75. Appendix II, 192, p. 710.
suppuration (on surface) II. 114, p. 66;
116, 117, p. 67.

• (in interior), osteo-myelitis,

II. 69 to 74 inclusive, pp. 59-60 ; 92,
p. 62^ 118 to 123 iuclusive, pp. 67-68 ;
150, p. 74. Drawings Nos. 1, 2.
necrosis. II. 20 to 25 inclusive, pp. 51-52 ;
30 to 43 inclusive, pp. 53-54 ; 55, p. 57 ;
61, p. 58 ; 76, p. 60 ; 80 to 84, p. 61 ;

100, p. 64 ; 131 to 135, pp. 69-70 ; 163,
to 181 inclusive, pp. 75-77.

, from syphilis, II. 15, p. 50 ; 20,

21, p. 51 ; 30, p. 53 ; 190, p. 79.

— , after malarious fever, II. 36,

p. 53 ; 38, 40, 41, 42, p. 54 ; 170, p. 76 ;
177, p. 77. Appendix II. 194, p. 710.

, after small-pox, II. 90, p. 62.

caries, or ulceration of bone, (simple), II.
75, 76, 77, 79, p. 60 ; 88, 89, p. 62 ; 97,
p. 63; 124, 129, 130, p. 69; 56, 57,
p. 75.

(strumous), II. 99, p. 63 ; 185,

186, 187, p. 78.

— (syphilitic), II. 4, p. 47 ; 15,

p. 50 ; 18, 19, p. 51 ; 98, p. 53 ; 162, p. 75.

— of newly-formed bone, II. 112,
p. 65 ; 148, p. 73 ; 160, p. 75.

abscess, II. 56, 56a, p, 57 ; 151, p. 74.
periostitis, II. 13, p. 49 ; 113, 114, 115,
pp. 65-66 ; 149, p. 73.
nodes of, 18, p. 51 ; 145, p. 73 ; 158,
162, p, 75. Appendix II. 192, p. 710.
Bones, rickety — see rickets.

Bones, tumours of —

exostoses, II. 26, 27, p. 52 ; 48, p. 55 ;
85, p. 61 ; 137, p. 71.

hyperostoses, II. 565, p. 57 ; 86, p. 61 ;

139, p. 71 ; 162, p. 75.
osteophytes, II. 85, p. 61 ; 138, p. 71.
mixed osseous (osteo-sarcoma, &c.), II.
28, p. 53 ; 44, p. 54 ; 49, p. 55 ; 52,
p. 56 ; 62, p. 58 ; 86a, p. 61 ; 93, p. 62 ;

101, p. 64 ; 140, p. 71. Appendix II.
196, 197, p. 711. — (See also XVII., es-
pecially osteomata, 122 to 136 inclusive,
pp. 563-69).

Brain (and membranes), laceration of, I.
11, 14, 15, p. 7; 16, p. 8; 22, p. 9.
VIII. 1, 2, p. 244 ; 47, p. 256.

... , with extravasation

of blood into, VIII. 3 to 17 inclusive,
pp. 244-48 ; 48, p. 256. Drawing No. 34.

, softening of, VIII. 12, 13, pp. 246-

47 ; 17, 18, 19, 20, pp. 248-49. Draw-
ing No. 33.

, abscess of, VIII. 21 to 26 inclusive,

pp. 249-50.

— — , induration (sclerosis) of, VIII 27,
p. 250.

, atrophy of, VIII. 28, p. 251.

, pigmentation of (malarial), VIII. 29

to 34 inclusive, pp. 251-52. Drawing
No. 39.

GENERAL INDEX.

721

Brain (anil membranes), morbid growths : —
glioma, VII r. 35, 30, p. 252 ; 61, 62, 63,
pp. 259-60.

gumma, VIII. 37, 38, 39, 40, 41, pp.

253-54 ; 64, 65. p. 260.
tubercle, VIII. 42, 43, pp. 254-55 ; 58, 59,
60, pp. 258-59.

carcinoma, VIII. 44, 45, p. 255.
psammoma, VIII. 66, p. 261.
ostcophites, VIII. 67, p. 261.
meningocele, VIII 46, p. 256. Drawing
No. 32.

(See also XVII— especially “glioma” and
“ psammoma ”).

Brain, thickening and opacity, &c. of mem-
branes (inflammation) VIII. 49 to 56
inclusive, pp. 256-58.

, hydrocephalus— see hydrocephalus.

, blood-vessels of: —

arteries, —see arteries (cerebral),
veins and sinuses — see veins (cerebral),
choroid plexuses, — see choroid plexuses.

Breast (female), cyst of, XV. 25, p. 485.

, lactating, Model Nos. 82, 83, 84.

tumours and morbid growths of —
fibroma, XV. 1, p. 477.
sarcoma, XV. 2, 3, 4, 5, pp. 478-79.
adenoma (chronic mammary tumour),
XV. 6, 7, 8, 9, pp. 479-80. XVII. 174,
175, 176, 177, pp. 578-79. Drawing
No. 135.

lipoma, XVII. 96, p. 555.
carcinoma (scirrhus), XV. 10 to 18 in-
clusive, pp. 481-83. XVII. 183 to 194
inclusive, pp. 581-85. Models Nos. 51,
52.

, (enkephaloid), XV. 19, 20, 21,

pp. 483-84. XVII. 195, 196, p. 585.

, (colloid), XV. 22, p. 484. XVII.

206, p. 588.

- •, (epithelioma), XV. 23, 24, p.

484.

Breast (male), tumours of —
fibroma, XV. 26, p. 485.
carcinoma, XV. 27, p. 485. Model No.
53.

sarcoma, XV. 28, p. 486.

Broad ligament, cysts of, XIV. 37, p. 455 ;
102, p. 469.

, fibroma of, XV. 103, p. 470.

Bronchi — see larynx, lungs.

Bronchial glands, caseous infiltration, VII.
49, 50, 51, p. 219.

, pigmentary infiltration,

VII. 51, 52, 53, 54, pp. 219-20.

— , carcinoma of, VII. 55, p.

220.

Bulbous extremities of nerves, — see nerves.
Burn, cicatrices from, XVI. 59, 60, p. 501.
Bursa, inflammation of, IV. 10, p. 99.
Buttock, tumours of, XVII. 76, p. 548 ;

94, p. 555 ; 160, p. 574 ; 267, p. 603.
Ccocum — see intestines.

Calculi, &c., from the urinary and digestive
organs, also concretions from other parts
of the body, XX. 1 to 288, pp. 643-82.
(See also kidney, bladder, urethra,
biliary, intestinal).

Cancer (carcinoma) — see tumours.

Capsules (supra-ronal) — see supra-renal cap-
sules.

Carbuncle — Drawing Nos. 69, 70.

Caries— see bone.

Carotid artery — see arteries.

Carpal and wrist-joints — see joints.

Carpus, fracture of, I. 90, p. 24.

Cartilages, ulceration of — see joints.

Casts, Appendix A, I. 1 to 25 inclusive,
pp. 685-89.

Cerebral arteries— see arteries.

— membranes —see brain.

■ — veins or sinuses — see veins.

Cervical vertebrae — see spine

Chancre, (hard), XIII. 9, 10, 11, p. 433-34.

, (soft), XIII. 13, 14, p. 434.

Chest-wall, tumours of, Cast No. 11. Draw-
ing, Nos. 105, 106.

Cholera, affection of the intestines in — see
intestines.

— — affection of the kidney in— see

kidney (hypencmia).

, prominence and enlargement of

lingual papillae in — see tongue.

, enlargement and tumefaction of

mesenteric glands in— IX. 244, p. 331.
Choroid plexuses, morbid growths of, VIII.
71, p. 262 ; 88, 89, 90, pp. 266-67. XVII.
171, 172, 173, pp. 577-78.

Cirrhosis— see liver.

Clavicle, fracture of, I. 64, 65, p. 20.

, caries of, II. 63, p. 58.

Clitoris— see vulva.

Club-foot, XVIII. 18, 19, p. 620.

Colon— see intestines.

Cord, umbilical— see umbilical cord.

Coronary arteries — see heart.

Corpora lutea, XIV. 25, p. 453 ; 29, p. 454 :
66, p. 462 ; 95, 96, 97, p. 469.

Cranium — see skull.

Curvature of spine — see spine.

Cysts, sebaceous, XVI. 16, 17, p. 493: 86, 87.
p. 509. XVII. 260 to 270 inclusive,
pp. 603-4 ; Appendix VII. 158, p. 715.

mucous, XVII. 271, 272, 273, p. 604.

, serous, XVII. 274 to 278 inclusive,

p. 605.

, sanguineous, XVII. 279, 280, p. 606.

, colloid, XVII. 281, 282, 283, p 606.

, multilocular or compound, XVII. 265,

p. 603 ; 285 to 290 inclusive, pp. 606-

— . proliferous, (including dentigerous,
dermoid, &c.), XVII. 291 to 295 in-
clusive, pp. 608-9.

— , congenital, XVII. 296, 297, p. 610.

Diphtheria, IX. 11, p. 281.— Nee also larynx.

Dislocations, of spine (cervical region), I.
36, p. 13 ; 42, 44, p. 14 ; 46, 47, 48, 49^
pp. 15-16 ; 58, p. 19.

, (dorsal region), I. 50,

51, p. 17.

— — — — (lumbar region), I. 55,

56, 57, p. 18.

of the elbow, 1. 94, 95, 96, p. 25

of the hip, I. 183, p. 40.

— of the knee, I. 184, p. 40.

722

GENERAL INDEX.

Dislocations, of the ankle, I. 151, p. 35 ;

185, 180, 187, 188, pp. 40-41.

Distomata — see entozoa.

Distortion of pelvis from rickets, &c., — see
pelvis.

Diverticula in intestine — see intestine.

Dorsal vertebrae, diseases of —see spine.
Drawings (pathological). Appendix A. III.

1 to 140 inclusive, pp. 690-707.

Duodenum, effects of poison, IX. 63, 64,
pp. 294-95. Drawing No. 43.

■ , inflammation of, IX. 65, p. 295.

, enlargement of glands in

cholera— see intestines.

Duramater, inflammation, morbid growths,
&c.,— see brain.

Dysmenorrhceal coagula, &c. , — see uterus.
Dysentery — see intestines.

Ear (external), fibroma of, XYI. 19, 20, 21,
pp. 493-94. XVII. 65, 66, p. 544.

, , enchondro-sarcoma of, XVI.

22, p. 494.

, angioma of, XVII. 256, p, 602.

, (internal), inflammation and suppura-
tion, XVI. 18, p. 493.

Echinococci (hydatids)— see entozoa.

Elbow, dislocations of — see dislocations.
Elbow-joint, diseases of —see joints.
Elephantiasis— see skin, scrotum, foot, vulva,
&c.

, Graccorum — see leprosy.

Emphysema of lungs — see lungs.

Empyema — see lungs (pleura).

Enchondrotna — see tumours.

Enlargement of prostate gland (chronic)—
see prostate gland.

Entozoa : —

distoma hepaticum, XIX. 1, 2, 3, 4,
p. 630 ; 63, p. 40.

distoma conjunctum, XIX. 5, 6, 7, pp.

630-31.

distoma sinense (McConnelli), XIX. 8 to 13
inclusive, pp. 631-32.
amphistoma hominis, XIX. 14, p.632.
t£enia solium, XIX. 15 to 19 inclusive,
pp. 633-34.

tcenia mediocanellata, XIX. 20 to 24 in-
clusive, p. 634.

t:enia serrata, XIX. 64, p. 640.
hydatids (echinococci), XIX. 25, 26, 27, 28,
pp. 634-35 ; 69, 70, p. 641.
cysticerci, XIX. 65, 66, 67, 68, pp. 640-41.
ascaris lumbricoides, XIX. 29 to 35 in-
clusive, pp. 636-37-

trichocephalus dispar, XIX. 36 to 42
inclusive, p. 637.

oxyuris vermicularis, XIX. 43, 44, p. 637.
oxyuris curvula, XIX. 71, 72, p. 642.
filaria (dracunculus) medinensis, XIX. 45
to 51 inclusive, p. 637-38.
filaria hominis oris, XIX. 52, p. 638.
dochmins duodenalis (sclerostoma duode-
nalis), XIX. 53 to 62 inclusive, pp.
638-40.

filaria megastoma, XIX. 73, 74, p. 642.
filaria ocuJi, XIX. 75, p. 642.

(See also with reference to entozoa, liver,
gall-bladder, intestines, &c.).

Epiphyses, separation of, I. 161, p. 37 ; 184,

_ p. 40 ; 188, p. 41.

Epithelioma (epithelial cancor) — see tu-
mours.

Erysipelas, Model No. 10.

Excision of joints, III. 4 to 10 inclusive,
p. 85 ; 12, 13, p. 86 ; 19, 20, pp. 87-88.
Appendix III. 57, 58 p. 711.

Exfoliated portions of bone, II. 25, P. 52 ;
34, 36, p. 53 ; 38, 40, p 54 ; 81, 82, 84,
p. 61 ; 100, p. 64 ; 132, 133, 134, p. 69 ;
171 to 176 inclusive, pp. 76-77. Appen-
dix II. 193, 194, 195, p. 710.

(See also bone (necrosis of).

Extravasation of urine — see urine
Extremities (upper or lower) deficient — see
monstrosities.

Eye, arcus senilis of cornea, XVI. 1, 2,
p. 488.

, glaucoma of, XVI. 3, p. 4S8.

, morbid growths : —

glioma, XVI. 4 to 8 inclusive, pp. 488-
89. XVII. 20, 21, 22, pp. 529-30.
carcinoma, XVI, 9, 10, 11, pp. 490-91.
XVII. 197, 198, p. 585; 230, p.

595. Model Nos. 54 to 58 inclusive,
fibroma, XVI. 12, p. 491.
gumma, XVI. 13 p. 491.
lymphoma, XVI. 14, p. 492.
papilloma, XVI. 15, p. 492. XVII. 166,
p. 576.

sebaceous cyst, XVI. 16, 17, p. 493.
Face, carcinoma of, Model No. 60.

Fallopian tube, dilatation and dropsy of,
XIV. 70, p. 463 ; 76, p. 464 ; 98, 99,
100, p. 469. Drawing No. 99.
1 inflammation and suppura-
tion of, XIV. 70, p. 463 ; 101, p. 469.

■ tubercle of, XIV. 76, p.

464 ; 100, p. 469.

Femur, caries of, 11.112, p. 65; 124 to
130 inclusive, p. 69.

, fractures of : —

intracapsular (of neck), I. 106 to 113
inclusive, p. 27.

extracapsular (of neck), I. 114 to 120 in-
clusive, pp. 28-29.

of shaft, 1. 121 to 138 inclusive, pp.
29-33.

— — , inflammation of, (ostitis and peri-
ostitis), II. 107 to 117 inclusive, pp.
65-67.

, necrosis of, II. 114, p. 66 ; 127,

p. 69 ; 131 to 136 inclusive, pp. 69-70.

■ , rickets, II. 103, 104, 105, p. 64.

, sci’ofulous disease, II. 106, p. 64.

— , suppuration (osteo-myelitis), II. 118

to 123 inclusive, pp. 67-68. Drawing
No. 2.

— . tumour’s, &c., II* 137, 138, 139, 140,

p. 71.

Fibrous and fibro-cystic tumours — see
tumours (fibroma).

Fibula, fractures of, 1. 173 to 177 inclusive,
pp. 38-39.

, atrophy of, II. 141, p. 72.

, inflammation (ostitis) of, II. 146,

147, p. 73.

GENERAL INDEX.

723

Fibula, caries of, II. 127, p. 65) ; 159, 161,

— , necrosis of, II. 160, 164, p. 75 ;

160, 170, 172, p. 70; 176, 179, ISO,
p. 77.

, rickets II. 144 p. 72.

Filarijo— see entozoa.

Fingers, deformities of, XVIII. 16, 17, pp.
619-20. Drawing No. 140.

, tumours of, XVII. 102, 103, p. 556 ;

116, p. 560; 208 p. 589; 226, p. 593.
Fistulre, — see bladder, urethra, vagina, &c.
Foetuses, aborted and prematurely expelled,
XVIII. 34 to 60 inclusive, pp. 624-26.

• , diseased full-term, XVIII. 61, 62,

63, p. 626.

— — , spontaneous evolution of, XVIII.

64, p. 626.

• , immature (equine), XVIII. 98,

p. 628.

Foetal membranes, diseases of : —

apoplexy, XVIII. 27, 28, p. 623 ; 32,
33, p. 624.

Foetation, extra-uterine, XVIII. 23, p. 621.
Foot, elephantiasis Arabum (buenemia
tropica) of, XVI. 45, p. 498 ; 76, 77,
p. 506. Model No. 37.

, mycetoma or fungus disease of, XVI.

88, p. 509 ; 89 p.^510 ; 92, 93, p. 511 ;
94, 95, 96, pp. 513-14. Drawing
Nos. 110, 111, 112.

, tumours of, XVII. 27, p. 531 ; 33,

p. 533 ; 36, p. 534 ; 42, p. 537 ; 79, 80,
p. 549 ; 101, 104, p. 556 ; 161, p. 575 ;
201, p. 586 ; 217, p. 590; 231, 232, p.
595 ; 27S, p. 605.

Foramen ovale, — see heart.

Forearm, fractures of : —
both bones, I. 71, p. 21 ; 83 to 87 in-
clusive, pp. 23-24.
radius, I. 77, p. 22 ; 88, 89, p. 24.
ulna, I. 76, p. 22.

• , tumours of, XVII. 1, 2, 5, 6, 9,

11, pp. 522-25 ; 29, p. 531 ; 34, 35, p.
533; 43, 45, pp. 537-38; 119, 120, p.
561 ; 151, p. 600. Drawing No. 114.
Fractures, compound, I. 69, 71, 74, p. 21 ;
75, 76, 77, p. 22 ; 83 to 87 inclusive,
pp. 23-24; 91, p. 24; 146, 148, 149,
p. 34 ; 151, p. 35 ; 156 p. 36 ; 164, 165,
p. 37 ; 169, 170, p. 38. Appendix I,
200, p. 70S.

■ , starred, I. 11, p. 7.

— , linear, I. 6, p. 6 ; 23, p. 9 ; 25,

p. 10 ; 26, 28, p. 11.

— . depressed (of skull), I. 5, p. 5 ;

7, 8, 10, p. 6. ; 11, p. 7 ; 19, 20, 21, 22,
pp. 8-9 ; 25, 27, pp. 10-11.

, , (of inner tablo of skull

only), I. 3, 4. p. 5 ; 11, p. 7.

, transverse, I. 79, p. 22 ; 88, p. 24 ;

143, 150, p. 34 ; 157, p. 36 ; 165, p. 37 ;
168, p. 38.

— — , oblique, I. 121 to 125 inclusive,

pp. 29-30 ; 128, 129, 130, p. 30 ; 134,
p. 31 ; 136, 137, p. 32 ; 144, p. 34 ; 159,
p. 36; 163, p. 37 ; 171, p. 38; 173 to
177 inclusive, pp. 38-39.

Fractures, impacted, I. 114, 116, p. 28 ;
118, p. 29.

— — , comminuted, (of long bones),

I. 69, 72, 73, p. 21 ; 78, 80, p. 22 ; 82,
p. 23 ; 89, 90, p. 24 ; 92, p. 25 ; 109,
p. 27 ; 118, 122, p. 29 ; 131, 133, 135,
p. 31 ; 136, p. 32 ; 139, 140, 141, p. 33 ;
145, 147, p. 34 ; 153, p. 35 ; 158, p. 36 ;
160, 162, P. 37 ; 167, 172, p. 38.

. , (of hat bones), I.

1, p. 5 ; 11, p. 7 ; 19, 20, 21, 22, pp.
8-9 ; 25, p. 10 ; 27, p. 11 ; 63, p. 20.

, , (of cuboid or

irregular bones), 1,37, 41, p. 13; 52,
p. 17 ; 56, p. 18 ; 66, p. 20 ; 102, p. 26 ;
105, p. 27 ; 178 to 182 inclusive, pp.
39-40. Appendix I. 198, p. 708.

, vertical, I. 155, p. 35; 160, p. 37.

, incomplete, I. 160, p. 37 ; 168,

p. 38.

, into joints — see joints.

, union of, (by fibrous tissue), I.

116, p. 28 ; 137 p. 32.

• , , (by bone ensheathing the

fragments), I. 61, p. 19 ; 64, 67, p 20 ;
93, p. 25 ; 112, p. 27 ; 118, p. 29.

, , (by bone inlaid between

the fragments), I. 3, p. 5 ; 53, p. 18 ;
65, p. 20 ; 114, p. 28 ; 123, p. 29 ; 125,
128, 129. p. 30 ; 134, p. 31 ; 144, p. 34 ;
174, p. 38; 175, p. 39 ; 189, p. 41.

— — — , >, (by bone forming

bridges between the fragments), I. 130,
p. 30 ; 132, 135. p. 31 ; 136, p. 32 ; 140,
p. S3 ; 145, p. 34 ; 154. p. 35 ; 173. p. 38.

- , ununited, 1. 110 to 113 inclusive,

p. 27; 122, p. 29; 149, p. 34; 163,
p. 37 ; 189, p. 41.

false-joint after, I. 106, p. 27.

, union of two bones of a limb

after, 1, 144, 145, p. 34 ; 154, p. 35.
Frontal bone, fractures of, I. 1, 4, p. 5 ; 6,
8, p. 6 ; ll to 19 inclusive, pp. 7-8.
Fungus-disease (mycetoma) — see foot, hand,
skin.

Gall-bladder, atrophy of, IX. 365, p. 356.
calcareous infiltration of walls, IX. 375,
p. 357.

, dilatation of, IX. 269, p. 335 ;

360, p. 356 ; 366, 367, 368, p. 357.

• .occupied by calculi, IX. 367

and 369 to 375 inclusive, p. 357.

, ulceration of, IX. 376, p. 357.

Gallstones —see bile-ducts, gall-bladder, &c.
Gland, prostate — see prostate gland.

Glands, lymphatic, morbid infiltrations and
growths : —

scrofulous or tubercular, IX. 245 to 257
inclusive, pp. 332-33. X. 88, 89, p. 379.
lymphomatous, IX. 258, 259, 260, pp. 333-
34. X. 90, p. 379.

calcareous, IX. 257, p. 333 ; 261, p. 334.
carcinomatous, IX. 262, p. 334. X. 91 to
95 inclusive, pp. 380-81.
sarcomatous, X. 96, 97, p. 381.
syphilitic, X. 98, p. 382.
pigmentary, X. 99, p. 382.

Glands, bronchial - see bronchial glands.

724

GENERAL INDEX.

Glands, of intestine — see intestines.

Gians penis — see penis.

Gouty disease of joints of the hand — Draw-
ing No. 6. -

Granular kidney — see kidney.

Groin, tumours of, XVII. 18, p. 528 ; 91,
p. 554 ; 95, p. 555 ; 143, p. 570.

Gunshot wounds — see the various organs.

Guinea worm — see entozoa.

Hrematocele — see testicle.

Haemorrhoids — see rectum.

Hair, in contents of cysts— see cysts (denti-
gerous, &c).

Hand, distortion of joints of in gout — see
gouty disease of joints of hand.

, fungus disease (mycetoma) of,

XVI. 90, 91, p. 511.

— , bones of : —

caries, II. 78, p. 60 ; 95 to 99 inclusive,
p. 63.

necrosis, II. 100, p. 64.
tumours of, II. 93, p. 62; 101, p.
64. XVII. 3, p. 522 ; 15, p. 527 ; 41, p.
536 ; 60, p. 543; 200 p. 586; 258,

p. 602.

ulceration of, Drawing No. 73 .—See also
skin.

Head, injuries and diseases of — see fractures,
brain, &c.

Heart— Injuries

rupture, VI. 25 to 30 inclusive, pp. 115-17.

Appendix VI. 345, p. 712.
gunshot wound, VI. 33, p. 119.

, Malformations : —

bifid apex, VI. 149, 150, p. 148.
perforation or arrested development of
septum ventriculorum, VI. 151, 152,
153, 154, pp. 148-50. Drawing No. 22.
permanent patency of the foramen ovale,
VI. 154 to 160 inclusive, pp. 150-51.
Drawing X o. 23.

pulmonary valves, two in number, VI.
161, 162, pp. 151-52.

pulmonary valves, four in number, VI. 163,
p. 152.

aortic valves, two in number, VI. 164 to
169 inclusive, p. 152.

fenestration or cribriform condition of the
valves, VI. 171 to 180 inclusive, p. 153.
Drawing No. 24.

, Diseases : —

rupture, VI. 31, 32, p. 18.
general dilatation (without proportion-
ate hypertrophy) VI. 65 to 79 inclusive,
pp. 126-29, 186 ; p. 154.
dilatation, partial or local (aneurismal
pouching), VI. 31, p. 118 ; 80 to 86
inclusive, pp. 129-31 ; 100, p. 136.
Appendix VI. 346, p. 713.
hypertrophy of one or more parts without
proportionate dilatation, VI. 46 to 66
inclusive, pp. 123-24 ; 131, p. 143.
hypertrophy and dilatation in about equal
proportions, VI. 57 to 64 inclusive,
pp. 124-26 ; 115, p. 139.
deposits and morbid growths : —
inflammatory, VI. 101, p. 136 ; 117,
p. 140 ; 120, p. 141 ; 125 Jo 137 in-

Heart — continued.

elusive, pp. 142-45; 151, p. 148.
Drawing Nos. 9, 11.

non-inflammatory (fibrinous concretions
or cardiac polypi) VI. 85, p. 131 ; 98,
p. 135 ; 117, p. 140 ; 138 to 148 in-
clusive, pp. 145-47. Drawing Nos. 19,
20, 21.

carcinomatous, VI. 98, 99, p. 135.
syphilitic or gummatous, VI. 100, p. 136.
degeneration of : —

fatty (infiltration), VI. 87 to 90 in-
clusive, p. 132.

(metamorphosis), VI. 32, p. 118;

35, p. 120 ; 63, p. 126 ; 69, p. 127 ; 87,
p 132 ; 91 to 94 inclusive, pp. 132-33 ;
186, p. 154.

fibroid (induration), VI, 95, 96, 97, pp.
133-34.

g- inflammation and ulceration of,

(myocarditis), VI 5, p. Ill ; 34 to
37 inclusive, pp. 120-21 ; 125, p. 142.

- suppuration of (pyeemic), VI. 38,

p. 121.

haemorrhage into, VI. 39, 40,

p. 122.

* atrophy of, VI. 41 to 45 in-

clusive, pp. 122-23; 182, 183,185, p. 154.
Heart, valves of: —

laceration of chordae tendineae, VI. 101,

102 pp. 136-37.

thickening or induration (with or without
contraction or adhesion, &c.) , VI. 60,
p. 125 ; 64, 66, p. 126 ; 67, 68, 70, p.
127 ; 75, p. 129 ; 81, p. 130 ; 85, p. 132;

103 to 119 inclusive, pp. 137-40.
Appendix VI. 347, p. 713. Drawing

No. 13.

ulceration, Assuring, or perforation (old
or recent), VI. 63, p. 126 ; 101, p. 136;
108, p. 138 ; 113, 115, p. 139; 119, p.
140 ; 120, 122, p. 141 ; 125, 126, 127, 128,
131, pp. 142-143. Drawing Nos. 10, 12.
aneurismal or pouched condition, VI. 129,
130, p. 143. Drawing Nos. 16, 17, 18.
Heart, blood-vessels of: —
atheromatous (including calcareous de-
generation), VI, 50, p. 123 ; 121, p. 141 ;
182 to 186 inclusive, p. 154.
aneurismal dilatation, VI. 187, p. 155.
abnormal origin, VI. 62, 64, pp. 125-26 ;
188, 189, p. 155.

Heart, pericardium : —

acute 'inflammation, VI. 1 to 9 inclusive,
pp. 111-12. Drawing No. 8.
chronic inflammation, VI. 12 to 20 in-
clusive, pp. 113-14.

attrition and other marks, (“white
patch”), VI. 21 to 24|inclusive, pp. 114-15.
hydro-pericardium, VI. 10, p. 112.
pyo-pericardium, VI. 11, p. 112.
Hepatization of lungs— see lungs.

Hernia, inguinal, IX. 183 to 188 inclusive,

pp. 321-22.

infantilo, IX. 189, 190, 191, p. 322.

congenital, IX. 192, 193, p. 323

.. ■ , strangulated, IX. 194, 195, 196,

pp. 323-24.

GENERAL INDEX.

725

Hernia, ventral, IX. 197, 198, p. 324.

, diaphragmatic, IX. 199, p. 3-4.

— results of operation for radical euro

of, IX. 200, 201, pp. 324-25.

Hip, — see joints.

H orse-shoe kidney, — see kidney.

Humerus, fractures of, I. 68 to 81, inclusive,
pp. 21-23.

caries of, II. 75 to 79 inclusive, p. 00.
hypertrophy of, II. 65, 66. p. 58.
inflammation (ostitis) of II. 67, 68, p. 08.
necrosis of, II. 76, p. 60 ; 80 to 84 in-
clusive, p. 61. _

suppuration (ostco-myelitis), II. 69 to /4
inclusive, pp. 59-60. Drawing No. 1.
tumours, II. 85, 86, 86«, p. 61.

Hydatids,— see entozoa, liver, &c.

Hydrocele, — see testicle.

Hydrocephalus, II. 2, p. 47. XVIII. 63,
p. 626 ; 67, p. 627. Cast No. 14.

Hydronephrosis, — see kidney.

Hydrophobia, condition of fauces, tongue,
&c., in, IX. 7, p. 279 ; 18. p. 282. .

— condition of cicatrix in the

skin, XVI. 62, p. 502.

Ileum — see intestines.

Ilium, fractures of — see pelvis.

Iliac region, tumours of, XVII. 109, p. 558 ;

254, p. 601.

Iliac artery — see arteries.

Impacted fractures — see fractures.
Incomplete fractures —see fractures.

Infantile hernia — see hernia.

Inflammation — see the parts affected.
Inguinal glands — see glands.

Inguinal hernia— see hernia.

Innominate artery — see arteries.
Intervertebral cartilage— see spine.
Intestines, effects of external force, IX. 57
to 62 inclusive, pp. 293-94.
effects of poisons, IX. 63, 64, pp. 294-5.
amyloid degeneration, IX. 66, 67, 68,
p. 295.

follicular enlargement (irritation) of
glands in , cholera, IX. 69 to 73 in-
clusive, pp. 295-96.

simplo ulceration, IX. 74, 75, 76, pp. 296-
97.

tubercular ulceration, IX. 77 to 86 in-
clusive, pp. 297-98.

typhoid ulceration, IX. 87 to 105 inclusive,
pp. 298-306.

dysenteric ulceration : —
acute catarrhal, IX. 106 to 111 inclusive,
pp. 307-308.

acute catarrho-fibrinous or sloughing,
IX. 112 to 121 inclusive, pp. 308-10.
Drawing Nos. 49, 50, 51.
acute fibrinous, IX. 122 to 128 inclusive,
pp. 310-11.

chronic, IX. 129 to 143 inclusive,
pp. 311-14.

repair or healing of dysenteric ulcers,
IX. Ill, p. 308 ; 132, p. 312 ; 138,
p. 313 ; 141, 142, 143, pp. 313-14.

, perforation of, (small), IX, 75,

p. 296 ; 99 p. 303 ; 144 to 147 in-
clusive, pp. 314-15.

Intestines, perforation of, (large), IX. 113,
p. 308 ; 148, p. 315 ; 170, p. 318 ; 203,
p. 325.

, , (from lumbrici),

IX. 149 to 152 inclusive, p. 315.
Drawing No. 54.

, gangrene of (and sloughs) IX.

115, p. 308 ; 133, p. 312 ; 153 to 164
inclusive, pp. 315-17 ; 194, 195, 196,
pp. 323-24.

, intussusception of, IX. 165 to

173 inclusive, pp. 317-19.

, internal strangulation of, IX.

174 to 182 inclusive, pp. 319-21.
Drawing No. 55.

, stricture of, IX. 202, 203, 204,

p. 325.

, morbid growths of, IX. 169,

p.318; 213 to 217 inclusive, pp. 327-
28. Drawing No. 56.

, malformations: —

diverticula, IX. 218 to 224 inclusive,
p. 328.

abnormal vermiform appendix, IX. 225,
p. 328.

imperforate anus, IX. 226 to 230 in-
clusive, pp. 328-30.

, preparations illustrative of dis-
ease, from the lower animals, IX. 231 to
237 inclusive, pp. 330-31.

Intestinal worms — see entozoa.

calculi— see index to Series XX.

p. 645.

Intussusception — see intestines.

Inversion of uterus — see uterus.

Jaw-bones, fracture of, I. 20, p. 8; 29, 30,

pp. 11-12.;

, necrosis of, II. 29 to 43 inclusive,

pp. 53-54. Appendix II. 193, 194, p. 710.

, tumours of (upper), XVII. 46,

47, pp. 538-39 ; 59, p 543 ; 67, p. 544 ;
68, 70, p. 545; 71, p. 546 ; 112, p. 559 ;
127«, p. 565. Drawing No. 120.

-, (lower), XVII. 14, p. 527 ; 44,

p. 538 ; 56, p. 542 ; 57, 58, p. 543 ; 62,
63, p. 544 ; 69, p. 545 ; 74, 75, p. 547 ;
80, p. 549 ; 111, p. 559; 123, 124,
p. 563 ; 127, p. 565. Drawing Nos. 121,
122, 123, 124, 125.

Joints, ankylosis, soft, III. 13, p. 86 ; 34,
p. 90 ; 46, p. 92.

, bony, III. 6, 8, 9, 11,

p. 85 ; 14, p. 86 ; 22, 23, p. 88 ; 47 to 50
inclusive, pp. 92-94.

— , abscesses communicating with, III.
29, p. 89 ; 35, 37, 38, p. 90 ;' 39, p. 91 ;
45, 47, p. 92 ; 48, 49, pp. 93-94.

— , amputation in injuries or diseases
of, III, 16, p. 87 ; 35, 37, 38, p. 90 ; 43,
p. 92 ; 49, P. 94 ; 53, 54, 55, 56, p. 95.
— , dislocation of, in disease, III. 51,
p. 94. Drawing No. 3.

— , excision or resection of — see excision
of joints.

— , injuries or wounds of, III. 7 to 10
inclusive, p. 85 ; 35, 37, 38, p. 90.

(gunshot), III. 12, 13, p.

86 ; 16, p. 87 ; 52, p. 95.

726

GENERAL INDEX.

Joints, pysemic affections of, III. 1, p. 84 :
41, p. 91 ; 52, p. 95.

rheumatic affections of, III. 15,
p. 86 ; 21, p. 88 ; 42, p. 91.

, scrofulous or strumous disease of,

III. 3, p. 84 ; 19, p. 87 ; 20, p. 88 ; 33,
p. 89 ; 34, p. 90 ; 47, p. 92 ; 56, p. 95.

-, articular surfaces of bone : —

caries of, III. 2, p. 84 ; 4, 5, p. 85 ; 17,
18, p. 87 ; 20, p. 88 ; 28, 30, p. 89 ; 36,
p. 90 ; 43, 47, p. 92 ; 56, p. 95.
Appendix, III, 57, 58, p. 711.
necrosis of, III. 5, p. 85 ; 18, p. 87 ; 32,
33, p. 89 ; 45, p. 92 ; 49, p. 94.

■ , cartilage of : —

absorption or ulceration, III. 2, p. 84 ; 4,
p. 85 ; 17, 19, p. 87 ; 24 to 34 inclusive,
pp. 88-90 ; 36, 37, 3S, p. 90 ; 41, p. 91 ;
43 to 49 inclusive, pp. 92-94.
Appendix III. 58, p. 711.

, repair after, III. 31 p. 89.

— — — , ligaments of : —
softening and ulceration, III. 2, p. 84 ; 17,
19, p. 87 ; 24 to 27 inclusive, pp. 88-89 ;
32, 33, 34, pp. 89-90 ; 39, 41, p. 91 ; 43,
45, p. 92.

— — , synovial membrane of : —
inflammation, (acute), III. 1, p. 84 ; 24,
p. 88 ; 37 to 43 inclusive, pp. 90-92 ; 45,
p. 92.

, (chronic), III. 25, 26, p. 88 ;

27, 29, 30, 33, p. 89 ; 34, p. 90 ; 40, p. 91 ;
44, 46, 47, p. 92 ; 48, p. 93 ; 49, p. 94.

* — . excrescences, or warty growths of,

III. 28, p. 89 ; 40, p. 91 ; 44, p. 92.

, disease of ankle, III. 53, 54, p. 95.

repair after amputation at, III. 541, p. 95.
Casts Nos. 2, 3.

— , disease of elbow, III. 4 to 13 in-

clusive, pp. 85-86.

, hip, III. 17 to 23 in-
clusive, pp. 87-88.

■ , — knee, Jill. 24 to 52 in-

clusive, pp. 88-95. Appendix III. 58,
p. 711.

— — , phalangeal, III. 14. p. 86.

, shoulder, III. 2, 3, p. 84.

Appendix, III. 57, p. 711.

, sterno-clavicular, III. 1 ,

p. 84.

. tarsal, III. 55, 56, p. 95.

, wrist and carpal, III. 14,

15, 16, pp. 86-87.

, fractures into: —

ankle, I. 145, 146, 148, p. 34 ; 151,155,
p. 35 ; 156, p. 36 ; 172, p. 38 ; 175, 176,
177, p. 39.

elbow, I. 73, p. 21 ; 78, 79, 80, p. 22.
hip, I. 106, 107, 108, 110, 112, 113, p. 27 ;
141, p. 33.

knee, I. 132, 133, p. 31 ; 136, p. 32 ; 138,
p. 33 ; 153, p. 35.
shoulder, I. 69, p. 21.
wrist, 1, 85, 86, 89, 90, p. 24.

Keloid growths of the skin, XVI. 70, p. 504.
Appendix XVI. 97, p. 717.

Kidney, atrophy of

in consoquenco of disease, XI. 9, 10,
p. 385 ; 12 to 16 inclusive, p. 386.
senile, XI. 17 to 21 inclusive, pp. 387-88.
— — , amyloid or albuminoid degeneration
of, XI. 33, 35, p. 391 ; 42, p. 392 ; 46,
p. 393 ; 49, p. 394 ; 59 to 66 inclusive,
pp. 397-99 ; 69, p. 399.

— , calculus in, XI. 86, 87, p. 402 ; 90,
p. 403 ; 92, p. 404 ; 96 to 101 inclusive,
p. 405. _

, cystic degeneration or cystic disease
of, XL 74 to 84 inclusive, pp. 400-402.
Drawing Nos. 85, 86.

--.fatty degeneration of, XI. 67 to 70

inclusive, p. 399.

, hydro-nephrosis and pyo-nephrosis,

XI. 87, p. 402 ; 91 to 95 inclusive,
pp. 403-404 ; 125, p. 411.

, hypertrophy of , XI. 6 toll inclusive,

p. 385 ; 13, 16, p. 386 ; 87, p. 402.

, hypersemia of, XI. 22, 23, 24, p. 388.

Drawing Nos. 76, 77, 78, 79.

, haemorrhage into, Drawing Nos.

80, 81.

— , infarctions, XI. 102, 103, p.

405-406. Drawing No. 82.

, inflammation of (acute nephritis),

XI. 25 to 29 inclusive, pp. 389-90.

} , (chronic

nephritis) : —

tubal nephritis or large white kidney,
XI. 30 to 37 inclusive, pp. 390-91 ; 59,
p. 397 ; 64, 65, 66, pp. 398-99. Model
No. 77. Drawing No. 84.
iutertubal nephritis or small granular
kidney, XI. 38 to 50 inclusive, pp.
392-94; 81, p. 401.

, malformations of : —

horse-shoe kidney, XI. 86, p. 402; 110
to 116 inclusive, pp. 408-9. Drawing
No. 87.

with double ureter, XI. 121, 122, pp.
410-11.

, misplaced, XI. 57, p. 396 ; 117,

118, 119, pp. 409-10.

— single or solitary, XI. 120, p. 410.

, morbid growths : —

carcinomatous, XI. 109, p. 408.
gummatous, XI. 107, p. 407.
sarcomatous, XI. 109, p. 408.
tubercular, XI. 104, 105, 106, p. 406.

, pyelitis, XI. 52, p. 395 ; 85 to 90

inclusive, pp. 402-403.

, rupture or effects of external in-
jury, Xf. 1 to 5 inclusive, pp. 384-85.

, scrofulous (phosphatic) degener-
ation of, XI. 71, 72, 73, pp. 399-400.

, suppuration of

in disease of genito-urinary tract, XT.

51, 52, 53, pp. 394-95. Drawing No. S3,
pysemic, XI. 54 to 58 inclusive, p. 396.
Drawing No. 82.

Knee, dislocation of, — see dislocations.
Knee-joint, injuries and diseases of, — see
joints.

Labium pudendi, diseases and morbid
growths of,— see vulva.

GENERAL INDEX.

727

Larynx, trachea, and bronchi, diseases of
the mucous membrane, and sub-mu-
cous tissue : —

acute inflammation and oedema, VII. 6
to 15 inclusive, pp. 209-12.
crupous or dipthcritic inflammation, VII.

16 to 20 inclusive, p. 212. IX. 11, p. 281.
ulceration (simple), VII. 14, p. 211 ;
21, p. 213.

, (tubercular), VII. 22, 23,

24, 27, pp. 213-14; 28, 30, p. 215 ; 32,
33, 34, 36, p. 216.

, (syphilitic), VII. 25, 26,

p. 214 ; 29, 31, p. 215 ; 35, p. 216.
Appendix VII. 159, p. 715.
abscess, VII. 11, p. 210; 31, p. 215:
37, p. 216; 42, p 217. IX. 15, p. 281.
slouching, VII. 38, p. 217. IX. 14,

p 281.

thickening and induration, (chronic
inflammation), VII. 39 to 41a inclusive,
p. 217.

, diseases of cartilages and connect-
ing membranes, VII. 40, 42, 43, pp.
217-18.

, dilatation of the bronchial tubes.

VII. 46, 47, 48, p. 219 ; 63, 66, p. 221 ;
99, p. 228.

, obstruction of, by foreign bodies,

VII. 4, 5, p. 209 ; 20, p. 212.

, wounds and other mechanical

injuries, VII. 1, 2, 3, p. 209.

, entozoa, VII. 44, 45, p. 218.

, morbid growth,— Appendix VII.

158, p. 715.

Laryngotomy and tracheotomy, illustrations
of, VII. 7,8,11, p.210; 12, 13, 15, p.
211 ; 17 to 20 inclusive, pp. 212-13 ; 25,
p. 214 ; 42, p. 217. Appendix VII.
162, p. 715.

Lateral curvature of spine, — see spine.

Leg, fracture of both bones of, I. 143 to 161
inclusive, pp. 34-37.

, tumours of, XVII. 19, p. 529 ; 25, 2S,

p. 531 ; 39, p. 535 ; 107, 108, p. 557 ;
110, p. 558 ; 125, p. 564 ; 130, p. 566 ;
131, p. 567 ; 134, 135, pp. 568-69 ; 157,
p. 574 ; 213, p. 589 ; 218, p. 590. Model
No. 62. Drawing Nos. 116, 118, 129,
130, 131, 133, 134

Leprosy, Model No. 36. Drawing Nos. 100,
101, 102, 103.

, thickening and enlargement of

the nerves in, VIII. 110, 111, p. 270.
Ligament, broad,— see broad ligament.
Ligaments, ulceration of, — see joints.

Ligaturo of arteries, — see arteries.

Linear fracture, — see fractures.

Lip, tumours of, XVII, 107, 212, p. 589 ;

216, p. 590; 220, p. 591.

Lithotomy, effects of,— see bladder.

Lithotrity, , — see bladder.

Liver, abscess of : —

single or solitary, IX. 286 to 299 inclusive,
pp. 339-41. Drawing No. 62.
multiple and pysomic, IX. 300 to 306
inclusive, pp. 342-44. Drawing Nos. 51,
58, 59, 60, 61. ' b

Liver, abscess of —continued.
perihepatic, IX. 307 to 311 inclusive,
pp. 344-45. Appendix IX. 382, p. 716.
Drawing No. 63.

Liver, blood extravasation at surface of,
IX. 266, 267, p. 335.

, cirrhosis of, IX. 268 to 277 in-
clusive, pp. 335-36. Appendix IX.

382, p. 716. Model No. 76.

, effects of pressure upon, IX. 265,

p. 335.

, entozoa occupying : —

hydatids (echinococci), IX. 348 to 351
inclusive, p. 353.

distomata, IX. 352 to 356 inclusive,

pp. 353-55.

, malformation of, IX. 357, 358 p. 355.

, morbid growths and infiltrations : —

amyloid or albuminoid degeneration, IX.
283, p. 338 ; 325 to 328 inclusive,

P. 347.

carcinoma, IX. 333 to 342 inclusive, pp.
349-52. Drawing Nos. 64 to 69 in-

clusive.

cystic, IX. 344 to 347 inclusive, pp. 352-
53.

fatty, IX. 321 to 325 inclusive, pp. 346-
47. Drawing No. 72.
lymphomatous, IX. 329, 330, p. 348.
sarcomatous, IX. 343, p. 352.

, pigmentation of : —

malarial, IX. 314 to 320 inclusive, pp.

345-46. Drawing No. 39.

“nutmeggy,” IX. 312, 313, p. 345.

Drawing No. 71.
in cholaemia, Drawing No. 70.

, syphilitic, (hepatitis syphilitica), IX.

278 to 285 inclusive, pp. 336-39.

, rupture of, IX. 263, 264, p. 334.

Lungs, abscess of : —
primary, VII. 67, p. 222.
pymmic, VII. 68, 69, 70, p. 222.

, atelectasis of, VII. 121, 122,

p. 235. Model Nos. 82, 83, 84.

, carnification of, VII 123 to 126

inclusive, p. 23o, 141, p. 238 ; 148,
149, p. 239 ; 151, p. 240 ; 157, p. 241.

, emphysema, VII. 127 to 131

inclusive, pp. 235-36.

, entozoa in, VII. 44, p. 218.

, gangrene of, VII. 71 to 75 in-
clusive, p. 223.

, haemorrhage into, VII. 92, 93,

pp. 226-27 ; 116 to 119 inclusive, p. 234.

, oedema of, VII. 120, p. 235.

, phthisis of : —

catarrhal, VII. 96 to 109 inclusive,
pp. 228-31. Appendix, VII. 161, p. 715.
fibroid, VII. 110 to 115 inclusive, pp
232-33. 1

tubercular, VII. 88 to 95 inclusive, pp.
225-27. Appendix VII. 160, p. 7157

, pneumonia : —

lobar, VII. 56 to 59 inclusive, p. 220 ;

67. p. 222. 1

lobular, VII. 60, 61, 62, pp. 220-21.
interstitial or chronic, VII. 63 to 66 in-
clusive, p. 221.

728

GENERAL INDEX.

Lungs, tuberculosis

acute, diffuse, VII. 76 to 82 inclusive,
pp. 223-24. Drawing No. 30.
chronic, limited, VII. 83 to 87 inclusive,
pp. 224-25. Drawing No. 31. —
(<See also phthisis.)

— — , pigmentary infiltration of, VII.
100, p. 229 ; 132, 133, 134, p. 236.

, tumours or morbid growths of : —

carcinoma, VII. 55, p. 220 ; 135 to 138
inclusive, p. 237.
sarcoma, VII. 139, p. 238.

• , pleura of : —

acute inflammation, VII. 60, p. 220 ;

123, p. 235; 141, 142, p. 238.
chronic inflammation, VII. 143 to 147
inclusive, pp. 238-39.

suppuration (empyema or pyo-thorax),
VII. 148 to 152 inclusive, pp. 239-40.
Appendix, VII. 161, p. 715.
morbid deposits and growths, VII. 123
p. 235 ; 132, p. 236 ; 135, p. 237 ; 150,
153, p. 240 ; 154, 155, 156, p. 241.
communication between lung and, IX.

143, p. 238 ; 149, p. 239.
communication between bronchi and, IX.
157. p. 241.

Lymphatic glands — see glands.

Malacosteon— see pelvis.

Malformation of parts (human) — see mon-
strosities.

■ ■■ — (in animals) — see

animals.

Mediastinum, tumours of, XVII. 148, 149,
p. 572.

Medullary cancer — see tumours (carcinoma).

Mesenteric artery — see arteries.

glands — see glands.

Mesentery, omentum and peritoneum — see
peritoneum.

Monstrosities. Union of two nearly distinct
foetuses, XVIII. 1 to 5 inclusive, pp.
616-18.

two bodies attached to a single head,
XVIII. 6, 7, 8, p. 618.
two heads attached to a single body,
XVIII. 9, 10, p. 618.

acephalous and anencephalous, XVIII. 11,
12, 13, pp. 618-19.

. , extremities increased in number,

XVIII. 14, p. 619.

extremities decreased, XVIII. 15, p. 619.
deformities of the fingers — see fingers.

foot, XVIII. 18 to 21

inclusive, p. 620.

false or shapeless conception, XVIII. 22,
p. 620. Drawing No. 139.
hermaphrodism, Drawing No. 138.

Mouth, tumours of, XVII. 61, p. 543 ; 215,
p. 590 ; 271, p. 604.

Muscles, acute inflammation of (myostitis),
IV. 5, 6, p. 98.

, fatty degeneration of, IV. 4, p. 98 —

(see also heart).

, laceration of, TV. 1, 2, 3, p. 97.

, lymphoid growth (in Hodgkin’s

disease), I V. 7, 8, p. 98.

Muscles, carcinoma (secondary), IV. 9, p. 99.

, pseudo-hypertrophic paralysis,

Drawing No. 7.

Mycetoma (fungus disease) — see foot, hand,
skin.

Myeloid tumours (sarcomata)— see tumours.

Natural or spontaneous amputation, II. 134,
p. 69.

Neck, tumours of, XVII. 40, p. 536 ; 97,
p. 555 ; 140, 144, p. 570 ; 146, p. 571 ;
156, p. 574 ; 265, 266, p. 603 ; 274,
p. 605. Drawing Nos. 127, 28.

Necrosis — see bone.

Nephritis — see kidney.

Nerves, cranial and spinal : —
irritation and inflammation of, VIII. 105,
106, p. 269.

bulbous enlargement of, VIII. 107, 108,
109, pp. 269-70.
fibroma of, VIII. 112, p. 271.

, enlargement and induration in

leprosy — see leprosy.

Neuroma — see tumours.

Nose, polypi of:—
fibroid, XVI. 23, 24, 25, pp. 494-95.
mucoid, XVI. 26 to 29 inclusive, p. 495.
adenomatous or glandular, XVI. 30, 31,
p. 496.

, gummatous growth of, XVI. 32, p. 496.

, tumours of, XVI. 33, p. 497. XVII.

83, p. 551 ; 117, p. 561 ; 202, p. 586.
Nymphae — see vagina.

Oblique fractures — see fractures.

Occipital bone, fractures of, I. 1, 5, p. 5 ;
22, 23, 24, pp. 9-10.

(Edema acute (spurious beri-beri), XVI. 36,
p. 497.

glottidis — see larynx.

(Esophagus, foreign body removed from, IX.

12, p. 281.

, perforation of, by a pigeon-bone,

IX. 13, p. 281.

, sloughing of mucous membrane,

IX. 14, p. 281.

— — , carcinoma of, IX. 16, p. 282.

, stricture of, IX. 16, 17, p. 282.

Onychia, XVI. 49, p. 499.

Optic thalamus — see brain.

Orbit, tumours of, XVII. 23, 24, p. 530 ;
179, p. 579; 252, p. 600; 257, p. 602.
(<8ee also eye).

Os uteri — see uterus.

Osteo-myelitis — see bone.

Ostitis — see bone.

Ova, diseased early, XVIII. 32, 33, p. 624.

, retention of ovum or foetus in uterus

after its death, XVIII. 24, 25, 26,

p. 622.

, preparations from animals, illustrating

malformations of— see animals.

Ovary, abscess of, XIV. 69 to 73, p. 463.

■ , atrophy of, XIV. 68, p. 463. ;

, congenital absence of one, XIV. 67,

p. 462.

, cysts of : —

simple, XIV. 3, p. 449; 35, p. 455; 77
to 80 inclusive, pp. 464-65.

GENERAL INDEX.

729

Ovary, cysts of— continued.
multilocular, XIV. 81 to 86 inclusive,
p. 465. XVII. 284, 285, p. 606 ; 288,
289, p. 607 ; 290, p. 608.
proliferous, XIV. 87, 88, 89, p. 466.
XVII. 2S6, p. 606 ; 291, p. 60S ; 295,
p. 609.

dentigerous, dermoid, &c., XIV. 90,91,
pp. 466-67. XVII. 292, 293, 294, p. 608.
Ovary, cysts removed by operation (ovari-
otomy), XIV. 92, 93, 94, pp. 407-68.

— — — , tumours and morbid growths: —
adenoma, XVII. 180, p. 580.
carcinoma, XIV. 53, p. 458 ; 55, p. 459 ;
75, p. 404. XVII. 205, p. 587.
Drawing Nos. 96, 98.
fibroma, XIV. 74, p. 404.
tubercle, XIV. 70, p. 464.

Pancreas, carcinoma of, IX. 377, 378, 379,
p. 358.

, hremorrhagic infarction of, IX.

380, p. 358.

, dilatation and obstruction of duct

by calculi, IX. 381, p. 359.

Pariotal bone, fracture of, I. 1 to 11 in-
clusive, pp. 5-7 ; 19, p. 8 ; 22, p. 9.
Parotid region, tumours of, XVII. 17, p. 528 ;
78, p. 548 j 84, p. 551 ; 113, p. 559 ;
178, p. 579. Drawing Nos. 127, 128.
Patolla, fracture of, I. 197, p. 42.

Polvis, fractures of : —
pubes, I. 99, p. 26.

and ischium, I. 100, 101, p. 26.

— — — , multiple fractures of, I. 102, 103,
104, p. 26. Appendix I. 199, p. 708.

■ , deformities of : —

from rickets, Cast Nos. 15 to 19 inclusive.

malacosteon, Cast No. 20.

oblique distortion, Cast Nos. 21, 22, 23.
masculine distortion, Cast No. 24.
kyphotic distoition, Cast No. 25.

Penis (and prepuce), hypertrophy of
(“Elephantiasis”;, XIII. 1,2,3, 4, p.
432; 26, 28, 29, p. 436 ; 30, 31, p. 437.
XVII. 87, 88, pp. 552-53. (See also
scrotum).

, hard and soft ehancro of, — see chan-

ere.

, malformation of, XIII. 23, p. 436.

, morbid growths of : —

warty (papilloma), XIII. 14, p. 434. XVII.

159, p. 574 ; 104, p. 575.
cancer (epithelioma), XIII. 15 to 22
inclusive, pp. 434-36. XVII. 209, 210,
211, p. 589 ; 221, 222, p. 591.

, ulceration of, XIII. 5, 6, 7, 8,pp. 432-33.

, wound of, XIII. 1, p. 432.

Perforation of intestine,— see intestine.
Pericardium— see heart.

Perinaeal abscess, fi.stulse, and section, — see
urethra.

Periosteum, holding fragments together in
fracture of bones, I. 62, p. 19 ; 88, p. 24.
Periostitis, — see bones.

Peritoneum (including the omentum and
mesentery), thickening and opacity,
(chronic inflammation), IX. 198, p. 324 ;
239, p. 331.

Peritoneum, wound, IX. 238, p. 331.

, tumours of, — see abdominal wall

and viscera.

Pharynx, — see oesophagus.

Placenta, diseases of : —
fatty degeneration, XVIII. 25, p. 622;

29, p. 623 ; 46, p. 625.
hydatidiform degeneration, X\ III. 30, 31,
p. 623. XIV. 61, 62, p. 462.

, “ battledore” orfan-shapod, XVIII.

65, p. 627.

Pleura,— see lungs.

Poisons— see stomach, intestines.

Polypus, - see nose, uterus, &c.

Popliteal space, tumours of, XVII. 49, p.
540 ; 133, p. 568 ; 142, p. 570 ; 163, p.
675.

Prepuce, — see penis.

Prolapsus, — see vagina.

Prostate gland, abscess of, XII. 13, p. 418 ;
38, p. 425 ; 54, p. 430. Drawing No.
83.

, chronic enlargement of, XII. 29,

p, 422 ; 49 to 53 inclusive, pp. 428-30.

, corpora amvlacea of, XII. 51, p.

428. XX. 258, p. 675.

, calculi of, XX. 257, p. 675.

, perforation of by instruments,

XII. 39, p. 425 ; 41, p. 426 ; 52, 53, pp.
429-30.

Psammoma, — see tumours (papillomata).
Pulmonary apoplexy, — see lungs.

Pustulse, — see skin.

Pyaemic lesions, in joints, III. 1, p. 84 ; 41,
p. 92 ; 52, p. 95.

, in the heart, VI. 38, p. 121.

, in the lungs, VII. 62, p.

221 ; 68, 69, 70, p. 222. ‘

, in the liver,- see liver (ab-
scess.)

, in the spleen, X. 34, 37.

p. 369 ; 46, 47, p. 371.

, in the kidney, XI. 54 to 58

inclusive, p. 396 ; 103, p. 406.

Radius and ulna, fractures of, — see forearm.

, caries of, II. 77, 78, 79,

p. 60 ; 88, 89, p. 62.

. necrosis of, II. 90, 91. p.

62. Appendix II. 195, p. 710.
, osteo-myelitis of, II. 92,

p. 62

, rickets of, II. 85, p. 61 ;

87, p. 62

Rectum, prolapsus of, IX 210, 211, 212, pp.
326-27.

, haemorrhoids of, IX. 207, 208,

209, p. 326.

Rheumatic arthritis — see joints.

Ribs (and sternum), fracture of, I. 61, 62,

63, pp. 19-20. Cast No. 1.
, melanosis of, II. 62,

p. 58. Drawing No. 4.

necrosis of, 11. 61, p.

58. 1

, rickets of, II 58, p. 57.

, syntosis of, II. 59,60,

pp. 57-58.

730

GENEBAL INDEX.

Rickets, II. 58, p. 57 ; 85, p. 61 ; 87, p. 62 ;
103, 104, 105, p. 64 ; 142, 143, 144,
p. 72. ( See also pelvis).

Rodent ulceration, — see skin.

Scalp, tumours of, XVII. 8, p. 524 ; 214,
p. 590 ; 223, p. 592 ; 268, p. 603.

Scapula, fractures of, I. 66, 67, p. 20.
Sclerostomata, — see entozoa.

Scrotum, elephantiasis of: —
simple, XIII. 24 to 31 inclusive, pp. 436-
37. Cast Nos. 12, 13. Drawing

Nos. 88, 90, 91, 92, 93, 94.
noevoid, XIII. 32, 33, 34, p. 437.
Drawing No. 95.

— > , results of opera-
tion for, XIII 35 to 39 inclusive, p. 438.
Drawing No. 89.

(See also penis and prepuce).

, warty growths of, XIII. 40, 41,

p. 438.

Sebaceous cysts, — see cysts.

Shoulder-joint diseases of, — see joints.

, fracture into, I. 69, p. 21.

Shoulder, tumours of, XVII. 90, p. 554 ; 100,
p. 556 ; 132, p. 567 ; 270, 272, p. 604 ;
280, p. 606. Drawing No. 119.

Skin, cicatrices of, XVI. 59 to 62 inclusive,
pp. 501-502.

, hypertrophy from pressure, XVI. 34,

35, p. 497.

, (and soft parts) gangrene of, XVI. 50

to 58 inclusive, pp. 500-501. Model
No. 71.

, ; , from frost-bite, XVI 55, p. 500.

, inflammation and ulceration of, XVI.

44, 45, p. 498 ; 57, p. 500 ; 76, p. 506.
Model Nos. 72, 73, 74.

, rodent ulceration, XVI. 46, p. 499.

— , morbid growths of : —
warts, XVI. 63 to 67 inclusive, pp. 502-3.
horns, XVI. 68, 69, p. 503. Model No.
63.

keloid, XVI. 70, p. 504. Appendix XVI.
97 p.717.

fibroma, XVI. 71, p. 504.
molluscum fibrosum, XVI. 72, 73, pp.
504-5. Cast No. 10. Drawing Nos. 105,
106, 107.

lipoma, XVI. 74, 75, pp. 505-6.
elephantiasis, XVI. 45, p. 498 ; 76, 77, p.

506. ( See also scrotum, foot, vulva, &c.)

carcinoma, XVI. 68, p. 503 ; 78 to 85 in-
clusive, pp. 506-9.

, mycetoma or “fungus-disease” : —

dark variety, XVI. 88 to 92 inclusive,
pp. 509-12.

pale or ochroid variety, XVI. 93 to 96
inclusive, pp. 512-1 5.— (See also foot,
hand, and Drawing Nos. 110, 111, 112.)

, pigmentation of, in disease, XVI. 37,

38, p. 498.

, , artifical (tattooing),

XVI. 39 to 43 inclusive, p. 498.

Skin-diseases, casts of — see index to Appen-
dix A (Casts) p. 683.

, models of — see index to

Appendix A (Wax models), p. 683.

Skin-diseases, drawings of —see index to
Appendix A. (Pathological drawings)
p. 684.

Skull, fractures of : —
vertex, I. 1 to 24 inclusive, pp. 5-10.
base, I. 20, 21, pp. 8-9 ; 25, 26, 27, 28,

pp. 10-11.

with depression, &c. — see fractures.

, multiple fracture from lightning, I.

33, p. 12.

— , gunshot injury, I. 31, 32, p. 12.

— , craniotomy, 33a, p. 12.

— , trephining of — see trephining.

— , separation of sutures of, I. 1 to* 5 in-
clusive, p. 5 ; 9, p. 6 ; 15, p. 7 ; 19, 20,
p. 8 ; 23, p. 9 ; 27, p. 11.

— , laceration of brain or membranes in
fracture of, I. 11, p. 7 ; 14, 15, 16,
pp. 7-8. _

— , laceration of blood-vessels in fracture
of, I. 2, p. 5 ; 6, 8, p. 6 ; 16, 20, p. 8 ;
22, p. 9.

— , diseases of bones of : —

atrophy, II. 8, p. 48.

caries, II. 3, p. 47 ; 14 to 20 inclusive,
pp. 50-51.

hydrocephalus, II. 2, p. 47. XVIII. 63,
p. 626 ; 67, p. 627. Cast No. 14.
hypertrophy, II. 1 to 7 inclusive, pp. 47-48.
inflammation, II. 4, p. 47 ; 12, 13, 14,
pp. 49-50.

microcephalus, II. 11, p. 49.
necrosis, 11. 15, p. 50 ; 20 to 25 inclusive,
pp. 51-52.

syntosis, II. 9, 10, p. 48.

, tumours of, II. 26, 27, 28, pp. 52-53.

XVII. 4, p. 522 ; 82, p. 550 ; 167, 168,
169, pp. 576-77.

, meningocele, VIII. 46, p. 256.

Small-pox — see skin-diseases.

Spina bifida, V. 23, p. 103.

Spinal cord, implication in diseases of, V. 8,
p. 101 ; 21, p. 103. Appendix V. 24, p. 711.

, laceration of, from external

injury, VIII. 93 to 97 inclusive, pp.
267-68.

, haemorrhage into, VIII. 98, p.

268 ; 102, p. 269.

, compression of, VIII. 94,

p. 267 ; 97, p. 268.

, softening, (not from external

injury), VIII. 99, 100, 101, p. 268.
Spinal membranes, effects of external injury
to, VIII. 93, p. 267 ; 97, p. 268.

, inflammation of (meningitis),

VIII. 103, 104, p. 269. Drawing Nos.
37, 38.

Spinal nerves — see nerves.

Spine, angular curvature of, V. 8, 9, p. 101 ;
10, 12, p. 102; 22. p. 103.

, lateral curvature, V. 7, p. 101.

— — , abscess accompanying disease of,

V. 20, 22, p. 103.

— , ankylosis of, V. 6, p. 101 ; 10, 13,

14, 15, 17, p. 102 ; 22, p. 103.

, caries of bones, V. 1 to 14 in-
clusive, pp. 101-2; 17, p. 102; 19, 20,
21, 22, p. 103.

GENERAL INDEX.

731

Spine, dislocations of •
in cervical region, I. 36, p. 13j 42, 44,
p. 14 ; 46 to 49 inclusive, pp. 15-16 ; 58,
p. 19.

in dorsal region, I. 50, p. 17.
in lumbar region, I. 55, 56, 57, p. 18.

— — , fibroid degeneration of bones,
Appendix V. 24, p. 711.

, fractures of : —

in cervical region, I. 34 to 45 inclusive,
pp. 13-15.

in dorsal region, I. 50, 51, p. 17. Appen-
dix I. 198, p. 708.

in lumbar region, I. 55, 56, 57, p. 18.

■ , gunshot injury, I. 58, 59, p. 19.

— , necrosis of bones, V. 8, p. 101 ; 10,

11, p. 102 ; 18, 22, p. 103.

— — , ulceration of intervertebral carti-
lages, V. 3, 7, 8, p 101 ; 11, 12, 13, p.
102 ; 18 to 21 inclusive, p. 103.

— , tumours of, V. 5, p. 101 ; 16, p.

102. Appendix Y. 24, p. 711.

, wound (by dhao), I. 60, p. 19.

, laceration of spinal cord or mem-
branes in fracture of, I. 36, 38, 40,
41, p. 13; 42, 44 p. 14; 45 to 49 in-
clusive, pp. 15-16 ; 54. 57, p. 18 ; 59,
p. 19. Appendix I. 198, p. 708.

• , diseases of cervical vertebras, V. 1

to 7 inclusive, p. 101.

, diseases of dorsal vertebrae, V. 7,

8, 9, p. 101 ; 10 to 15 inclusive, p. 102.

■ , diseases of lumbar vertebrae, V. 7,

8, p. 101 ; 10 to 19 inclusive, pp. 102,

103. Appendix V. 24, p. 711.

« — , diseases of sacral vertebrae, V. 22,

23, p. 103.

, diseases of coccyx, V. 22, p. 103.

Spleen, atrophy of, X. ”21 to 26 inclusive,
p. 368.

• , cirrhosis of, X. 38, 39, 40, p. 370.

• , hypertrophy of : —

acute (hyperaemic), X. 10, p. 366.
chronic (malarial), X. 11 to 18 inclusive,
pp. 366-67.

leucocythaemic, X. 19, 20, pp. 367-68.

■ — , infarctions of, X. 41 to 47 inclusive,

pp. 370-71. Drawing Nos. 73, 74.

— , inflammation (including abscess) of,

X. 32 to 37 inclusive, p. 369. Drawing
No. 75.

■ , malformations of : —

abnormal Assuring or lobulation, X. 70,
71, 72, pp. 375-76.

accessory spleens, X. 16, p. 367 ; 71, p.
375 ; 73, 74, 75, p. 376.

— — , morbid infiltrations and growths : —
amyloid or albuminoid, X. 48 to 54
inclusive, pp. 371-73. IX. 326, p. 347.
Appendix X. 105, p. 717.
cretaceous deposit, X. 66, p. 374.
cystic disease, X. 69, p. 375.
lymphadenoma (Hodgkin’s disease) X. 67,
68, pn. 374-75. Drawing No. 56.
pigmentary, X. 16. p. 367 ; 55 to 61 in-
clusive, pp. 373-74.

tubercular-, X. 62 to 65 inclusive, p. 374.

Spleen, removal of by ligature, X. 9. p. 366.

, rupture of, X. 1 to 8 inclusive, pp.

364-65.

, thickening of capsule of, X. 11, p.

366 ; 15, 16, 19, p. 367 ; 27 to 31
inclusive, pp. 368-69 ; 54, p. 373.
Appendix X. 104, p. 716.

Starred fracture, — see fractures.
Sterno-clavicular joint, disease of, III. 1,
p. 84.

Sternum (and ribs), — see ribs.

Stomach, carcinoma of : —
scirrlnts, IX. 48, 49, 50, pp. 289-91.
Model No. 64.

epithelioma, IX. 51. 52, 53, pp 291-92.

— , effects of irritant poisons : —

arsenic, IX. 20 to 24 inclusive, p. 283.
Model Nos. 66, 67. Drawings Nos. 42,
43, 44.

carbolic acid, IX. 27, p. 285.
oxalic acid, Model No. 68.
sulphuric acid, IX. 25, 26, p. 284.

, gunshot injury, IX. 19, p. 283.

. thickening of the walls : —

general, IX. 28 to 33, pp. 285-86.
limited, (fibroid), IX. 34, 35, p. 2S6.

, thinning of the walls, IX. 36, 37,

p. 287.

, perforation of, IX. 22, p. 283 ;

36, 38, 39, 41, p. 287; 45, 46, 47, p. 289.

— , ulceration of mucous membrai e,

IX. 30, p. 285 ; 36, 38 to 44 inclusive,
pp. 287-S8 ; 47, p. 289. Model No. 65.
Drawing No. 45.

Strangulated hernia — see hernia.
Strangulation internal— see intestines.
Stricture of oesophagus - see oesophagus.

urethra, — see urethra.

Stumps, after amputation, — see amputation.
Supra-renal capsules, morbid. growths of: —
fibroid, X. 85, 86, p. 378.
carcinoma, X. 87, p. 379.

Sutures, separation of,— see skull.

Synovitis, — see joints.

Syphilis, necrosis from,— see bone.
Syphilodcrmata, — see skin.

Talipes, — see club-foot.

Tarsus and metatarsus, caries and necrosis
of, II. 161, p. /5 ; 185 to 190 inclusive,
pp. 78-79.

ut-cnerauon

of bones of, II. 183, 184, pp. 77-78.

~ T •> — o rrr— > fracture of bones

of, T. 1/8 to 182 inclusive, pp. 39-40.

, disease of joints of,

— see joints.

Teeth, caries of, II. 53, 54, p. 57.

— . congenital abnormity of fane-s of
XVIII. 71, 72, p. 627. g ’

— , development of, XVIII. 70, p. 627.

, excessive tartaric deposit upon II
57, p. 57. ’

— , hyperostosis, II. 56 b, p. 57.

-, inflammation and abscess, II. 56

56a, p. 57.

— , necrosis of, II. 55, p. 57.

Temporal bone, fractures of, I. 6 v 6 • 90
P- 8 ; 21, p. 9; 26, 27, pi 11. ’ P ’ U

732

GENEKAL INDEX.

Temporal bone, extension of disease to, and
to the brain, from auditory canal, — see
ear.

Testicle, atrophy of, XIII. 42 to 49 in-
clusive, pp. 438-40.

• , chronic enlargement (orchitis),

XIII. 48, p. 440.

— , calcareous infiltration of tunica

vaginalis of, XIII. 69 to 75 inclusive,
pp. 442-43.

— , hsematocele, XIII. 63 to 66 in-

clusive, pp. 441-42.

■ , hydrocele (simple), XIII. 49 to

59 inclusive, pp. 440-41. XVII. 276,
p. 605.

• , , (congenital), XIII.

60, p. 441.

— , , results of operation

for radical cure of, XIII. 61, 62,
p. 441.

• , spermatocele, XIII. 45, 47,

p. 439.

■ , suppuration of tunica vaginalis of,

XIII. 67, 68, p. 442.

• , tumours and morbid growths : —

carcinoma, XIII. 80, 81, p. 445. XVII.
199, p. 586.

fibroma, XIII. 77, p. 443.
gumma (syphilitic orchitis), XIII. 78, 79,
p. 444.

sarcoma, XIII. 82, p. 445. XVII. 48,
p. 539.

sanguineous cyst, XVII. 279, p. 606.
tubercle (scrofulous orchitis), XIII. 76,
p. 443.

Thigh, tumours of, XVII. 16, p. 528 ; 32,
p. 533 ; 37, p. 534 ; 72, p. 546 ; 92, 93,
p. 554 ; 121, p. 562 ; 126, p. 563 ; 127,
p. 565 ; 128, 129, p. 566 ; 133, p. 568 ;
137, p. 569 ; 203, p. 586 ; 255, p. 601 ;
297, p. 610. Drawing Nos. 115, 117,
132, 136, 137.

Thoracic aorta, — see arteries.

Thyroid gland, hypertrophy of, X, 77, 78,
79, p. 376.

— , morbid growths of : —

fibroid, X. 80, p. 377.

cystic, X. 81 to 84 inclusive, p. 377. XVII.
273, p. 604 ; 281, p. 606.

Tibia, caries of, II. 127, 128, p. 69 ; 152 to
162 inclusive, pp. 74-75.
inflammation (ostitis) of, II. 145 to 149
inclusive, p. 73. Appendix II. 192, p.
710.

necrosis of, II. 157, 159, 160, 161, 163,
p. 75 ; 165, 167, 168, 169, 170, 171, 173,
174, p. 76; 175, 177, 178, 180, 181,
p. 77.

rickets, II. 142, 143, 144, p. 72.
scrofulous disease, II. 106, p 64.
suppuration (abscess), II. 151, p. 74.

. ■ (osteo-myelitis), II. 150, p. 74.

■ , fractures of, I. 163 to 172 inclusive,

pp. 37-38.

, gunshot fracture, I. 162, p. 37.

, fractures into knee-joint,— see joints.

, tumours of, II. 162, p. 75.

Appendix II. 196, 197, p. 711.

Drawing Nos. 118, 133, 134.

Tongue, carcinoma of, IX. 9, 10, p. 2S0
XVII. 224, 225, pp. 592-93.

, gangrene of, IX. 8, p. 279.

, papillae and mucous follicles of,

enlargement in cholera, IX. 1 to 6 in-
clusive, p. 279.

in hydrophobia, IX. 7, p. 279 ; 18, p. 282.

Tonsils, ulceration of. IX. 11, p. 281.

Trachea, injuries and diseases of, — see larynx.

Tracheotomy,— see larynx.

Trephining, illustrations of, I. 1, p. 5 ; 8,
10, p. 6. Appendix I. 203, 204, p. 709.

Tube, Fallopian, - see Fallopian tube.

Tumours — Adenomata : —

acinous, XVII. 174 to 180 inclusive, pp.
578-80. Drawing No. 135.

tubular, XVII. 181, 182, p. 580.

Angiomata : —

simple, XVII. 253, 254, 255, p. 601.
cavernous, XV1L 256, 257, p. 602.

Carcinomata : —

scirrhus, XVIT. 183 to 194 inclusive,
pp. 581-85. Model Nos. 51, 52, 53, 64.
enkephaloid, XVII. 195 to 203 inclusive,
pp. 585-86. Model Nos 54, 55, 56.
Drawing Nos. 136, 137.
colloid, XVII. 204, 205, 206, pp. 287-88.
epithelioma, XVII. 207 to 229 inclusive,
pp. 589-94. Model Nos. 60, 61, 62.
[melanotic, XVII. 230 to 233 inclusive,
p. 595.]

Cystomata, — see\ cysts.

Enchondromata : —

hyaline, XVII. 101 to 110 inclusive,
pp. 556-58.

fibroid, XVII. Ill to 115 inclusive,
pp. 559-60.

stellate, XVII. 116, p. 560.
enchondrosis, XVII. 117, p. 561.
osteoid tumour or periostoma, XVII.
118, p. 561.

encliondro-sarcoma XVIT. 119, 120, 121,
pp. 561-62. Drawing Nos. 127 to 132.

Fibromata : —

simple, XVII. 54 to 76 inclusive,
pp. 542-48.

mixed, XVII. 77 to 80 pp. 548-49.
Drawing Nos. 119 to 125.

Lipomata : —

simple, XVIT. 89 to 96 inclusive,
pp. 554-55.

mixed, XVII. 97 to 100 inclusive,
pp. 555-56. Drawing No. 126.

Lymphomata : —

simple, XVII. 137 to 146 inclusive,
pp. 569-71.

lymphadenoma, XVII. 147 to 156 in-
clusive, pp. 571-74

Myomata, XVII. 234 to 250 inclusive,
pp. 596-600.

{See also uterus.)

My'xomata : —

simple, XVII. 81, 82, 83, pp. 550-51.
mixed, XVII. 84. 85, p. 551.

Neuromata, XVII. 251, 252, p. 600.

Osteomata : —

simple (compact and spongy), XVII.
122 to 131 inclusive, 563-67.

733

GENERAL INDEX.

Tumours— continued. v-utt

Osteomata mixed (osteo-sarcom a), XV 11.
132 to 136 inclusive, pp. 567-69.
Drawing Nos. 133, 134.

Papillomata : — . .

cutaneous, XVII. 157 to 165 inclusive,

pp. 574-76.

mucous, XVII. 166, p. 576.
serous (psammoma), XVII. 167
inclusive, pp. 576-78.

( See also brain.)

to 173

Sarcomata: — .

round-celled, XVII. 1 to 13 inclusive,

pp. 522-27.

alveolar, XVII. 14 to 19 inclusive,

pp. 527-29.

glioma, XVII. 20 to 24 inclusive, pp. 529-
30.

spindle-celled, XVII. 26 to 40 inclusive,
pp. 531-36.

pigmented (melanotic), XVII. 21, p. 529 ;
41, 42, pp. 536-37).

myeloid, XVII. 43 to 47 inclusive, pp. 537-

mixed, XVII. 48 to 53 inclusive, pp. 539-
41. Model Nos. 57, 58, 59. Drawing
Nos. 114 to 118.

Tunica vaginalis, — see testicle.

Typhoid ulceration of intestine, — see intes-
tines.

enlargement and tumefaction of

mesenteric glands, IX. 99, p. 303 ; 100,
p. 304 ; 240 to 243 inclusive, p. 331.

Ulceration — see the name of the part affect-
ed.

Ulna — see radius.

Umbilical cord, with three veins, XVIII. 66,

p. 627.

Ununited fracture, — see fractures.

Ureter, dilatation of, XI. 52, p. 395 ; 91,
p. 403 ; 123, 124, p. 411.

. , impaction of calculi in, XI. 91,

p. 403 ; 98, p. 504 ; 123, 125, p. 411.

Urethra, stricture of, XII. 3, p. 416 ; 7, 8,
p. 417 ; 12, 13, 14, p. 418 ; 23, p. 421 ;
34 to 45 inclusive, pp. 423-27. Drawing
No. 83.

, ■ -, at the orifice, XII. 13,

P. 418 ; 34, 35, pp. 423-24.

, , near the meatus, XII.

3, p. 416 ; 35, 36, p. 424.

, , in the spongy portion,

XII. 34, p. 423 ; 40, 41, p. 426.

, , in the bulbous portion,

XII. 12, 14, p. 418 ; 23, p. 421 ; 37 to
42 inclusive, pp. 424-27.

, , in the membranous

portion, XII. 6, 7, 8, p. 417 ; 43, 44, 45,
p. 427.

, dilatation of, behind stricture,

XII. 3, p. 416; 7, p. 417 ; 37, p. 424;
39, p. 425 ; 41, p. 426 ; 45, p. 427.

, false-passages in, XII. 67, p. 417 ;

13, 14, p. 418 ; 15, p. 419 ; 33, p. 423 ;
39 to 42 inclusive, pp. 425-27 ; 45, 46,
p. 427 ; 47, p. 428.

, fistula (recto-urethral), XII. 32,

33, p. 423.

Urothra, fistula and abscess in pcrinaco, XII.
33, 34, p. 423.

. , results of perineal section, XU.

14, p. 418 ; 33, 34, p. 423 ; 39, p. 425 ;
44 d 427

_ ' calculi of, XX, 251 to 256a p. 675.

t rupture of, in fracture of pelvis,

I. 101, p. 26.

Urine, extravasation of : —

from rupture or injury to the bladder,
XII. 1, p. 416 ; 31, p. 422.
from rupture or laceration of the urettiia,
XII. 35, 36, p. 424 ; 39, p. 425 ; 40,
p. 426 ; 47, p. 423.

Urinary organs, calculi from,— see calculi.
Uterus, malformations of : —
bicormiate, XIV. 1, p. 449.
double, XIV. 2, p. 449.

, displacements of: —

anteflexion, XIV. 3, p. 449 ; 51, p. 458.

inversion, XIV, 4, p. 449.

, injuries of : —

punctured wound, XIV. 5, 6, pp. 449-50.

(See also results of abortion),
laceration or rupture during delivery,
XIV. 7, 8, 9, p. 450.
hysterotomy, XIV. 10, 11, p. 451.

Ctesarean section, XIV. 12, p. 451.

, diseases of: —

atrophy, XIV. 77, p. 464.
dysmenorrhoeal coagula, XIV. 33, 34,
p. 455.

hypertrophy (of cervix and os) XIV. 13,
14, p. 451.

(of the whole organ), XIV. 15 to

18 inclusive, p. 452.

[gravid uteri, XIV. 63 to 66 inclusive,
p. 462.]

laceration and sloughing after parturition,
XIV. 20, p. 452 ; 22, 23, p. 453.
inflammation, (metritis and endo-metritis),
XIV. 15 to 21 inclusive, p. 452.
results of abortion (criminal or othenvise),
XIV. 6, p. 450 ; 19, p. 452 ; 24 to 32
inclusive, pp. 453-55.

, tumours and morbid growths : —

carcinoma (scirrhus), XIV. 52, p. 458.

— (enkephaloid), XIV. 53 to 56,

pp. 458-59. Drawing Nos. 96, 97.

(epithelioma), XIV. 57 to 60

inclusive, pp. 460-61.

myoma and myo-fibroma, XIV. 35 to 51
inclusive, pp. 455-58. XVII. 234 to 249
inclusive, pp. 596-99.

uterine “mole” or “hydatids,” XIV. 61,
62, p. 462.

(.See also Model No. 78).

, retention of ovum in, after death, —

see ova.

Vagina, laceration of, XIV. 104, 105, 106,
pp. 470-71.

, fistula (recto-vaginal), XIV. 107,

p. 471.

, polypoid growth (fibroma), XIV.

110, p. 471.

, prolapsus, XIV. 108, p. 471.

734

GENERAL INDEX.

■ Vagina, slough, XIV. 20, p. 452.

, ulceration of, XIV. 109, p. 471. —

(See also vulva).

Valves of heart — see heart.

Veins, consequences of application of liga-
ture, VI. 32(? to 329 inclusive, pp.
200-201.

— , thickening of walls (inflammatory),
VI. 326 to 330 inclusive, pp. 200-201.

Vi. ozo to 66U inclusive, pp.

-, thrombosis of (recent), VI. 329 to
336 inclusive, pp. 201-202.

— , (older, undergoing

change), VI. 327, p. 201 ; 337 to 341
inclusive, pp. 202-203.

— , suppuration of (suppurative phleb-
itis), VI. 326, p. 200 ; 335, p. 202 ;

342, 343, pp. 203-204.

, wound of, VI. 325 p. 200.

Venous aneurism (iuematoma), VI.
p. 204.

344,

Ventral hernia, —see hernia. ' *

Ventricles of brain,— see brain. * _ *

— ; — heart, — see heart. * *

Vomicae,— see lungs. ** ♦ '

Vulva (including the clitoris and ' nymphaek
malformation of, XIV. Ill, p. 471. .

slough, XIV. 112, p. *472.

morbid growths : — „

elephantiasis, XIV. 113 to 119 inclusive,
PP- 472-73. XVII. 86, p. 552.
condylomata and warts, XIV. 121 to 126
inclusive, p. 473. XVII. 162, p. 575.
fibro-lipoma, XVII. 99, p. 556.

* Ik

'Warts and warty growths,— see skin, and
tumours (papillomata).

Worms, intestinal, — see entozoa. ’ .

Wormian bones, XVIII. 68, 69fp. 627.

Wrist’ and carpal' joints, diseases of,— see
joints.

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